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Vulnerable, But Why? Post-Traumatic Stress Symptoms in Older Adults Exposed to Hurricane Sandy
Abstract
Objective:
Drawing on pre-disaster, peri-disaster, and post-disaster data, this study examined factors associated with the development of post-traumatic stress disorder (PTSD) symptoms in older adults exposed to Hurricane Sandy.
Methods:
We used a sample of older participants matched by gender, exposure, and geographic region (N=88, mean age=59.83 years) in which one group reported clinically significant levels of PTSD symptoms and the other did not. We conducted t-tests, chi-square tests, and exact logistic regressions to examine differences in pre-disaster characteristics and peri-disaster experiences.
Results:
Older adults who experienced PTSD symptoms reported lower levels of income, positive affect, subjective health, and social support and were less likely to be working 4 to 6 years before Hurricane Sandy than were people not experiencing PTSD symptoms. Those developing PTSD symptoms reported more depressive symptoms, negative affect, functional disability, chronic health conditions, and pain before Sandy and greater distress and feelings of danger during Hurricane Sandy. Exact logistic regression revealed independent effects of preexisting chronic health conditions and feelings of distress during Hurricane Sandy in predicting PTSD group status.
Conclusions:
Our findings indicated that because vulnerable adults can be identified before disaster strikes, the opportunity to mitigate disaster-related PTSD exists through identification and resource programs that target population subgroups. (Disaster Med Public Health Preparedness. 2016;page 1 of 9).
... Older adults affected by hurricanes and floods may experience clinically significant anxiety, depressive, and PTSD symptoms, as well as suicidal ideation or plans [11,12,[36][37][38][39][40][41][42]. A rich body of research regarding the mental health impact of floods and hurricanes, including in aging adults, has emerged after Hurricane Katrina, which brought catastrophic floods to Louisiana, Mississippi, and Alabama in 2005, Hurricane Sandy, which struck the Eastern U.S. in 2012, causing widespread damage and human loss, and Hurricane Maria, which left behind widespread devastation in Puerto Rico in 2017. ...
... Research exploring older adults' post-traumatic growth and resilience in the aftermath of natural disasters is scarce. Many studies have focused on risk factors for post-disaster PTSD instead, defining resilience as the absence of PTSD symptoms [38,42,53,54]. These risk factors were reviewed in detail by Kellis et al. [55]. ...
... Most studies did not have control groups. Several authors stratified participant samples by age (although subgroup sizes were not always comparable, which limited statistical power for comparing mental health outcomes), and one study compared 44 older adults with PTSD to 44 without [42]. ...
Climate change is a major public health emergency. Natural disasters (earthquakes, floods, hurricanes, tornadoes, tsunamis, landslides, wildfires, and volcanic eruptions) have been increasing in frequency and severity and can cause lasting psychological sequelae. Older adults are highly vulnerable to the physical and mental health impacts of extreme weather and natural disasters. A narrative review was conducted to identify and summarize English-language articles focusing on the impact of climate change on older adults’ mental health. Sixty sources were identified. This review summarizes age-specific risk factors, clinical presentations (including anxiety, depressive, posttraumatic stress symptoms, and sleep disturbances), and management of psychiatric symptoms linked to climate change in the geriatric population. Older adults are highly vulnerable and can experience multiple mental health symptoms as a result of climate change. Clinicians should be aware and educated regarding the mental health impacts of climate change on older adults, so they can best support their patients.
... The negative impacts of hurricanes have been shown to be devastating for vulnerable populations such as older adults, resulting in a greater mental health impact (Lamb et al., 2008). Additionally, older adults may be impacted due to pre-existing vulnerabilities that have been linked to poorer mental health outcomes after past hurricanes as well as diminished overall preparedness and ability to cope with the aftermath of the disaster (Heid et al., 2016;Phifer & Norris, 1989;Pietrzak et al., 2012a;Sirey et al., 2017). Specifically, following Hurricane Sandy, depressive symptoms among older adults, aged ≥60 years, were as high as 14% and were found to persist 24-33 months after the hurricane (Sirey et al., 2017). ...
... Although studies have examined the mental health effects of hurricane exposure among the general population (Pietrzak et al., 2012;Schwartz et al., 2015Schwartz et al., , 2018Schwartz et al., , 2019, only a few have investigated these effects specifically among older adults post-Hurricane Sandy (Heid et al., 2016(Heid et al., , 2017Sirey et al., 2017). Of those that did, either only PTSD (Heid et al., 2016(Heid et al., , 2017 or only depression (Sirey et al., 2017) were modeled as an outcome so that comparisons of predictors for different outcomes could not be conducted. ...
... Although studies have examined the mental health effects of hurricane exposure among the general population (Pietrzak et al., 2012;Schwartz et al., 2015Schwartz et al., , 2018Schwartz et al., , 2019, only a few have investigated these effects specifically among older adults post-Hurricane Sandy (Heid et al., 2016(Heid et al., , 2017Sirey et al., 2017). Of those that did, either only PTSD (Heid et al., 2016(Heid et al., , 2017 or only depression (Sirey et al., 2017) were modeled as an outcome so that comparisons of predictors for different outcomes could not be conducted. Further, none of these studies examined multiple potential predictors together such as hurricane exposure, displacement, and lack of access to medical care in one overall model in order to examine the relative contributions of each on mental health. ...
Objectives
To examine whether hurricane exposure, lack of access to medical care (LAMC), and displacement during Hurricane Sandy were associated with PTSD and other mental health (MH) symptoms among older adult New York residents.
Methods
Participants ( N = 411) were ≥60 years old at the time of survey data collection (1–4 years post-Sandy). Outcomes included PTSD, depression, and anxiety symptoms and stress. Hurricane exposure, displacement, and LAMC were primary predictors.
Results
Older adults with greater hurricane exposure had increased PTSD, anxiety, and stress symptoms. LAMC had a strong association (ORadj = 4.11) with PTSD symptoms but was not associated with other MH symptoms. Displacement was not associated with MH outcomes.
Discussion
This is the first study to examine exposure, displacement, and LAMC together and to examine their varying impacts on different MH outcomes among older adults post-hurricane. Findings support the importance of disaster preparedness interventions tailored to the MH needs of community-dwelling older adults.
... [5][6][7][8][9] It appears, moreover, that certain seniors are especially vulnerable to the impacts of disaster events, [10][11][12][13][14][15][16] in particular individuals affected by health problems, loss of physical or cognitive autonomy, and hearing and mobility impairments. 3,6,[17][18][19] Research has shown that seniors are more vulnerable than other age groups to the risk of injury and death during and in the aftermath of exposure to natural disasters. 12,[20][21][22][23][24] disabilities, as well as those living on low incomes and those without a social support network, are among the groups rec- ...
... Previous studies have also identified some of these same health problems as consequences of exposure to disaster events, including hypertension, fatigue, stress and anxiety, as well as sleeping disorders. 6,11,17,33 According to Tyler and Hoyt, 38 certain manifestations frequently present themselves following a natural disaster, including depressive symptoms 38 and PTS manifestations 61 ; this was also the case for participants in the present study. ...
... The same vulnerability factors have been reported previously by a number of authors. 12,17,48,[74][75][76][77] Participant testimonies reflected the scope and gravity of material damages to both personal goods and public infrastructure, as well as the emotions linked with these losses, in particular anguish, stress, and insecurity. The emotional impacts of material losses are significant, because they may be at the origin of subsequent mental health difficulties. ...
The article aims to describe the medium-term impacts of a major earthquake event (Chile, February 27, 2010) on 26 seniors. The authors adopted a qualitative study approach. Data obtained using the Impact of Event Scale–Revised (IES-R) show the presence of manifestations of posttraumatic stress in the majority of respondents. In addition, data collected in interviews demonstrated a progressive deterioration of the health of respondents over a period of 4 years following the disaster. Seniors are particularly vulnerable to the effects of material loss, emotional stress, and postdisaster health complications. These impacts are exacerbated by low economic status. Furthermore, broader research is necessary involving elderly living in poverty who have survived natural disasters and others without such experiences, in order to better identify and differentiate between health complications associated with exposure to disaster events and those linked more strictly with natural aging processes.
... When facing natural disasters, resilient outcomes were more likely among individuals with higher levels of educational attainment and more reliable employment (Mandavia & Bonanno 2019, Tang et al. 2014. Unsurprisingly, preexisting mental illness and other psychopathology symptoms have often been identified as predictors for more symptomatic (i.e., nonresilient) trajectories (Heid et al. 2016, Mandavia & Bonanno 2019, Zhou et al. 2019, while higher negative affect (Mandavia & Bonanno 2019), poorer emotion regulation (La Greca et al. 2013), and decreased flexibility (Westphal et al. 2010) have been associated with a reduced likelihood of being in a resilience trajectory. Moving from intrapersonal to interpersonal, social support has been commonly identified as a correlate of resilience following both natural and human-made disasters (Bonanno et al. 2007, Lai et al. 2015, Mandavia & Bonanno 2019. ...
... Moving from intrapersonal to interpersonal, social support has been commonly identified as a correlate of resilience following both natural and human-made disasters (Bonanno et al. 2007, Lai et al. 2015, Mandavia & Bonanno 2019. Although relatively few studies have examined resilience at the family and community level, emerging evidence indicates that higher social cohesion (Heid et al. 2016), lower crime rates (Mandavia & Bonanno 2019), and less community exposure to disaster (Gruebner et al. 2016) are associated with resilience outcomes. ...
Disasters cause sweeping damage, hardship, and loss of life. In this article, we first consider the dominant psychological approach to disasters and its narrow focus on psychopathology (e.g., posttraumatic stress disorder). We then review research on a broader approach that has identified heterogeneous, highly replicable trajectories of outcome, the most common being stable mental health or resilience. We review trajectory research for different types of disasters, including the COVID-19 pandemic. Next, we consider correlates of the resilience trajectory and note their paradoxically limited ability to predict future resilient outcomes. Research using machine learning algorithms improved prediction but has not yet illuminated the mechanism behind resilient adaptation. To that end, we propose a more direct psychological explanation for resilience based on research on the motivational and mechanistic components of regulatory flexibility. Finally, we consider how future research might leverage new computational approaches to better capture regulatory flexibility in real time.
Expected final online publication date for the Annual Review of Psychology, Volume 75 is January 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... Furthermore, approximately one-fourth of Puerto Rican older adults lived alone in 2017, 57,58 and consistent with other studies, findings raise concerns for emotional well-being and social support in these high stress, uncertain contexts. 6,57,[59][60][61][62][63][64][65] While research shows that older adults are less likely to adequately prepare for natural hazards or heed warnings, 4,66-82 study participants described several community-level preparedness measures to protect older adults. Regardless, communities had not foreseen an extended recovery, indicative of broader disaster planning and risk communication inadequacies, which are not keeping stride with growing magnitudes of natural hazards and shifting demographics. ...
... 1,2,7,34,52,83,84 Hurricane Maria's severity and impact were exceptional, yet it was only 1 from a list of hurricanes that has disproportionately affected US older adults in recent years. [19][20][21]24,26,27,43,46,48,61,77,81,85 Hurricane Katrina in 2005 was a major impetus for the development of recommendations and trainings to better protect older adults, especially those with NCDs and low-income individuals. 5,29,31,86 However, 15 years later, there is either a lack of clarity regarding guidelines for older adults confronting large-scale natural hazards, or prior recommendations have not been adequately implemented, and Hurricane Maria brought to light the dire consequences of these deficiencies. ...
Objective
With natural hazards increasing in frequency and severity and global population aging, preparedness efforts must evolve to address older adults’ risks in disasters. This study elucidates potential contributors to the elevated older adult mortality risk following Hurricane Maria in Puerto Rico through an examination of community stakeholder preparedness, response, and recovery experiences.
Methods
In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities. Interview transcripts were deductively and inductively coded and analyzed to identify salient topics and themes representing participant response patterns.
Results
The hurricane’s detrimental impact on older adult health emerged as a prominent finding. Through 6 months post-hurricane, many older adults experienced unmet needs that contributed to declining physical and emotional health, inadequate non-communicable disease management, social isolation, financial strain, and excess morbidity and mortality. These needs were predominantly consequences of lengthy public service gaps, unsafe living conditions, interrupted health care, and the incongruence between preparedness and event severity.
Conclusions
In a landscape of increasing natural hazard frequency and magnitude, a pattern of older adult risk has become increasingly clear. Study findings compel practitioners to engage in natural hazard preparedness planning, research, and policy-making that considers the multiple facets of older adult well-being.
... Several previous studies indicated the factors associated with the development of PTSD in the elderly following natural disasters encompassing age ( Jia et al., 2010;Rafiey et al., 2016), education (Lamoureux-Lamarche et al., 2016;Pietrzak, Goldstein, Southwick and Grant, 2012;Pietrzak, Southwick, Tracy, Galea and Norris, 2012), gender (Chen et al., 2011;Hikichi et al., 2016;Lamoureux-Lamarche et al., 2016;Pietrzak, Goldstein, Southwick and Grant, 2012;Pietrzak, Southwick, Tracy, Galea and Norris, 2012), property loss and relocation (Chen et al., 2011;Hikichi et al., 2016), income and financial loss (Kohn et al., 2005) and chronic illness (Heid et al., 2016). In addition, pre-existing mental condition (Hikichi et al., 2016;Kohn et al., 2005;Pietrzak, Goldstein, Southwick and Grant, 2012;Pietrzak, Southwick, Tracy, Galea and Norris, 2012), distress and fear during disaster (Kohn et al., 2005;Pietrzak, Goldstein, Southwick and Grant, 2012;Pietrzak, Southwick, Tracy, Galea and Norris, 2012), injury and witnessing injuries or death ( Jia et al., 2010), living companions and supports (Hikichi et al., 2016;Lamoureux-Lamarche et al., 2016;Pietrzak, Goldstein, Southwick and Grant, 2012;Pietrzak, Southwick, Tracy, Galea and Norris, 2012), bereavement (Hikichi et al., 2016;Jia et al., 2010), religiosity (Chen et al., 2011) and mental health service utilization ( Jia et al., 2010) can also be the predictors of the PTSD occurrence. ...
... The likelihood of having a chronic illness and being diagnosed with PTSD was 2.490, which means that respondents who had a chronic illness had nearly 2.5 times higher odds of suffering PTSD than those who had not (95% CI 1.151-5.385). This finding corresponds with several studies that revealed that pre-existing chronic illness or pain can be a predictor and risk factor of PTSD occurrence (Akhtar et al., 2019;Chung et al., 2016;Heid et al., 2016;Palacio et al., 2012). The chronic condition can weaken the elderly's capacity to deal with a catastrophic event (Aldrich and Benson, 2008;Ford et al., 2006) and impair their functional ability, self-esteem and illness beliefs (Hill et al., 2010;Simpson et al., 2013). ...
Purpose
The purpose of this paper is to analyze factors associated with post-traumatic stress disorder (PTSD) among elderly who live in a post-earthquake area.
Design/methodology/approach
This was a cross-sectional study involving 152 elder people who survived the disaster and were selected conveniently. The study was conducted in two worst-affected districts of Lombok Utara regency. PTSD was diagnosed using a modified version of the Clinician-Administered PTSD Scale version 5 (CAPS-5). The demographic data were assessed using a self-developed questionnaire consisting of 13 items. All data were analyzed by descriptive analysis, χ² test and binary logistic regression with p <0.05.
Findings
Out of the 152 elder people, 91 (59.9 percent) suffered PTSD. Intrusion symptoms were the most common symptoms experienced by the respondents (94.1 percent). The factors associated with the PTSD in the elderly after the earthquake were having chronic illnesses (OR=2.490; 95% CI=1.151–5.385), public health center utilization (OR=2.200; 95% CI=1.068–4.535) and occupational status before the disaster (OR=2.726; 95% CI=1.296–5.730). These findings highlight that individual factors and access to health care services remain an important aspect of stress identification among the elderly following the disaster event.
Social implications
Elder people constitute a vulnerable group that is often forgotten and neglected during post-disaster recovery, though they have potentially higher psychosocial distress than younger age groups. This study was conducted to raise awareness about mental health problems suffered by the elderly.
Originality/value
This is the first study to apply CAPS-5 to assess PTSD among Indonesian elderly people following a natural disaster. This paper also provides insights that can be used by governments and other relevant parties to address PTSD problems suffered by many elderly people in a post-disaster area.
... In fact, only a handful of studies have tracked survivors a decade or more after the event (for exceptions, see Chen et al., 2016;Goenjian et al., 2018;McFarlane and Van Hooff, 2009;Oishi et al., 2015), and few other studies have pre-disaster data to isolate the effects of the natural disaster from confounding variables (for exceptions, see Frankenberg et al., 2008;Heid et al., 2016;Weems et al., 2007). No published paper to our knowledge has both. ...
... First, data on the RISK cohort were first collected before Katrina, a unique attribute among disaster studies. Findings from RISK (e.g., Rhodes et al., 2010) and other exceptional studies with pre-disaster data (e.g., Heid et al., 2016;La Greca, Silverman and Wassterstein, 1998;Weems et al., 2007) demonstrate pre-disaster functioning to be among the strongest predictors of post-disaster mental health, suggesting that studies lacking such data are overestimating the impact of disaster-related exposures and other factors on outcomes. Second, its focus on an at-risk sample of low-income parents, and primarily single Black women, permits exploration of factors that explain variation within this group in post-disaster mental health. ...
In August 2005, Hurricane Katrina caused unprecedented damage, widespread population displacement, and exposed Gulf Coast residents to traumatic events. The hurricane's adverse impact on survivors' mental health was apparent shortly after the storm and persisted, but no study has examined the long-term effects now that more than a decade has transpired. Using new data from a panel study of low-income mothers interviewed once before Hurricane Katrina and now three times after, we document changes in mental health, and estimate the sociodemographic and hurricane-related factors associated with long-term trajectories of mental health. We find that post-traumatic stress symptoms (PTSS) declined at each of the three post-Katrina follow-ups, but 12 years after the hurricane, one in six still had symptoms indicative of probable post-traumatic stress disorder. The rate of non-specific psychological distress (PD) remained consistently higher in all three follow-ups, compared to the pre-disaster period. In full covariate-adjusted models, no sociodemographic variables predicted long-run combinations of PTSS and PD. However, 12 years later, exposure to hurricane-related traumatic events and pre-disaster PD significantly predicted co-occurring PTSS and PD. Hurricane-related housing damage predicted PTSS in earlier follow-ups, but no longer predicted PTSS in the long-term. Furthermore, hurricane-related traumatic events significantly differentiated the risk of having persistent PTSS, relative to recovering from PTSS. The results suggest that there is still a non-negligible group of survivors with continued need for recovery resources and that exposure to traumatic events is a primary predictor of adverse mental health more than a decade post-disaster.
... 6,12,22 Older adults who lack physical and psychological capacities or resources before a disaster may be at greater risk after the disaster. 23 ...
... 45 However, there may be some added benefit to sustaining this collective approach by building social capital among neighbors. 23 Building social connections and resources for older adults disconnected within their communities may diminish the vulnerability that some older adults face and promote longerterm recovery for individuals and communities. For example, efforts such as those conducted through PROSPER, a multifaceted, collaborative community-level intervention designed to draw upon evidence-based prevention programs to build social capital, may offer insight into how to build lasting social relations among communities for older persons. ...
Objective
Individuals exposed to natural disasters are at risk for negative physical and psychological outcomes. Older adults may be particularly vulnerable; however, social support can act as a resource to help individuals respond to severe stressors. This study explored the challenges older people faced before, during, and after Hurricane Sandy in October 2012 and the people they turned to for support.
Methods
Semi-structured interviews were conducted with 20 older adults in New Jersey drawn from the ORANJ BOWL (Ongoing Research on Aging in New Jersey – Bettering Opportunities for Wellness in Life) research panel, who experienced high levels of primary home damage during Hurricane Sandy. Content analysis of interview transcripts classified older adults’ perceptions on how they “made it” through—the challenges they faced and the support they received.
Results
The findings suggested that older adults experienced emotional, instrumental, social, and financial challenges before, during, and after the storm. However, by relying on family and friends, as well as neighbors and community networks, older people were able to respond to stressors.
Conclusions
Our findings carry implications for ensuring that older adults are connected to social networks before, during, and after disasters. The role of neighbors is particularly important when disasters strike. ( Disaster Med Public Health Preparedness . 2016;page 1 of 9)
... Ontario education workers reporting excellent/very good health had lower IES scores than workers with poorer subjective health. The association between lower levels of subjective health and increased PTSD symptoms was also noted by Heid et al. [44]. These researchers found that subjective health was associated with PTSD symptoms as measured with the Post-traumatic Stress Disorder Symptom Scale-Self Report among Americans 50 years or older who had lived through Hurricane Sandy. ...
There is limited information regarding factors related to education workers’ responses to traumatic stress during the COVID-19 pandemic. The study goal was to determine whether personal factors, behaviours that mitigate viral spread, and work-related factors were associated with post-traumatic symptoms. This observational study, embedded within a cohort study, recruited Ontario education workers from February 2021 to June 2023. Exposure data were collected at enrollment and updated annually. Participants completed the Impact of Event Scale (IES) at withdrawal/study completion. Modified Poisson regression was used to build hierarchical models of dichotomized IES scores (≥26: moderate/severe post-traumatic symptoms). Of the 1518 education workers who submitted an IES between September 2022 and December 2023, the incidence rate ratio of IES scores ≥26 was significantly higher among participants who usually/always wore a mask at work (1.48; 95% confidence interval 1.23, 1.79), usually/always practiced physical distancing (1.31; 1.06, 1.62), lived in larger households (1.06; 1.01, 1.12), and reported poor/fair/good health (1.27; 1.11, 1.46). However, models accounted for little of the variance in IES scores, suggesting the need for future studies to collect data on other factors associated with the development of PTSD, such as pre-existing mental health challenges. Early identification of those experiencing traumatic stress and the implementation of stress reduction strategies are needed to ensure the ongoing health of education workers.
... However, age can also be protective, providing greater life experience in managing adversity and enhanced stress tolerance. Overall, research suggests that risk is predominantly associated with conditions of aging (cognitive difficulties, mobility limitations, vision impairment, and dependence on systems of care), rather than age per se (Heid et al. 2016). Ensuring that disaster messages are understandable, availability of transportation, and optimizing access to care in the post-disaster environment all serve to enhance outcomes for older adults. ...
Climate-related disasters are a profound and devastating effect of a changing global climate. These events result in an established range of individual psychological and behavioral responses as well as a predictable pattern of community responses that evolve over time. Unlike the medical impact of climate-related disasters, various factors enhance the transmission of mental health effects beyond the geography of the event. Subsequent and co-occurring disasters, such as the global COVID-19 pandemic, amplify distress and significantly complicate disaster response and community recovery. Certain populations are particularly vulnerable to the mental health effects of disasters with various communities disproportionately bearing the impacts. Understanding the effects of disasters, where risk is concentrated, and how it changes throughout the course of disaster response and recovery are important to optimize interventions. Evidence-informed interventions can reduce distress, improve well-being, enhance functioning, and foster sustainment for individuals, organizations, and other communities. Effective preparedness requires understanding these factors, incorporating them into all aspects of disaster management, and ongoing education and training for disaster planners, responders, and the public.
... children's fewer internalizing problems during the pandemic. Indeed, resilience outcomes are often observed in communities with higher social cohesion (Heid et al., 2016). Together, our findings highlight the roles of community-, family-, parent-, and child-level resources in shaping children's positive development. ...
Introduction
Children’s psychological adjustment to adverse events can be determined by multiple risk and resilience factors. This study explored multi-level protective factors against children’s internalizing problems and investigated the mechanism regarding how diverse environmental and child-level resources influence children’s mental health in the context of COVID-19.
Methods
Our participants included a nationally representative sample of 2,619 young children (48.3% girls) and their primary caregivers (95.1% mothers) in Singapore. They were a subset of the participants in the Singapore Longitudinal Early Development Study (SG LEADS). Data were collected over two waves—before the outbreak of the COVID-19 pandemic (Wave 1) when these children aged 3 to 6, and during the second year of the pandemic (Wave 2). Primary caregivers completed measures of verbal cognitive ability, self-control, economic stress, and positive and negative parental control in Wave 1. Children’s self-regulation was assessed by the Delay of Gratification task in Wave 1, and their internalizing problems were rated by their primary caregivers in both waves. Other pre-pandemic family and community characteristics were collected as covariates. Structural equation modeling was performed.
Results
Pre-pandemic parental resources (i.e., verbal cognitive ability, self-control, and low economic stress) predicted children’s fewer internalizing problems during the pandemic and less aggravation of internalizing problems from before to during the pandemic, through more positive parental control (i.e., limit setting) and less negative parental control (i.e., harsh discipline). Moreover, children’s self-regulation during early childhood was predicted by their primary caregivers’ verbal cognitive ability and self-control, as well as positive parental control. Early childhood self-regulation further alleviated the aggravation of internalizing problems over time. Among the covariates, parental education, family income, parental psychological well-being, living with both parents, having a live-in domestic helper, and neighborhood quality also longitudinally predicted fewer child internalizing problems.
Discussion
Our findings underscore the importance of nurturing children’s emotional resilience under adverse and uncertain circumstances by boosting protective factors in their social-ecological system, including community-, family-, parent-, and child-level resources.
... The development of post-traumatic stress disorder (PTSD) is considered the most severe health problem affecting marginalized communities in the post-disaster context. PTSD is a serious health problem that negatively influences a person's mental and physical well-being [17,[38][39][40][41][42][43][44][45][46]. Marginalized communities commonly experience waves of irresistible solid negative feelings, anxiety, helplessness, insecurity, grief, and flashbacks during the post-disaster context as symptoms of PTSD [1,4,31,43,[47][48][49][50][51][52]. ...
Many international organizations embrace the ideals of resilience and inclusion in the service of marginalized communities but neglect their inclusion in post-disaster settings. It is imperative to explore the challenges faced by marginalized communities to increase their inclusion in the post-disaster context. Therefore, this paper presents a systematic literature review of the challenges facing marginalized communities in the post-disaster context. The study identified 57 challenges faced by children, women, people with disabilities, and older adults under six categories: social, health, political, infrastructure, economic, and communication. The most common challenges all four marginalized communities face are the development of post-traumatic stress disorder, the struggle to acquire the necessities of life due to unequal distribution, the lack of income-generating opportunities, and sexual and gender-based violence. Most studies focus on women’s challenges, followed by those of children, older adults, and persons with disabilities. The study also explored the challenges faced in terms of intersectionality, experienced by groups of people who fall under more than one marginalized community. Finally, a conceptual framework was developed to improve the inclusion of marginalized communities during the post-disaster context by incorporating the challenges as one of the key components of the framework.
... Peritraumatic stress was assessed at Wave 4 using two questions: "Did you feel that you were in immediate physical danger during Hurricane Sandy?" and "Were you distressed or fearful during Hurricane Sandy?" Similar questions were asked by Heid et al. (2016) and Bell et al. (2017). Response options for each question were no (0), a little (1), and a lot (2). ...
Objectives
Natural disasters can have devastating, long-lasting effects on the mental health of older adults. However, few studies have examined associations among disaster exposure and positive and negative affect, and no longitudinal studies have investigated the extent to which pre-disaster perceived social support affects these associations. These analyses examine the associations among pre-disaster perceived social support, disaster exposure, and positive and negative affect experienced by community-dwelling older adults four years after Hurricane Sandy, controlling for pre-disaster affect.
Methods
Self-reported data collected before and after Hurricane Sandy from participants (aged 50-74 years) in the ORANJ BOWL panel (N=2442) were analyzed using linear regression models.
Results
Higher levels of peri-traumatic stress experienced during Hurricane Sandy and greater hardship experienced after the storm were associated with more negative affect four years following the disaster. Higher perceived social support at baseline was related to more positive affect and less negative affect both before and after the hurricane. Social support did not moderate the effect of hurricane exposure on either positive or negative affect.
Discussion
Findings suggest that psychological effects may persist years after natural disasters and that more effective interventions may be needed during and after a disaster. While social support is critical to positive and negative affect in general, its buffering effects when disaster strikes may be limited.
... Older populations and those of lower socioeconomic status have more difficulty returning to pre-event conditions (Quarantelli 1990). Older adults with higher vulnerability conditions (e.g., low levels of income, low functional ability, and more chronic medical conditions) and lower social support 4 to 6 years prior to Hurricane Sandy were more likely to have developed posttraumatic stress disorder syndrome after the storm (Heid et al. 2016). African American's perceived sense of recovery after Hurricane Katrina was predicted by their income and psychological distress (i.e., depression and anger), which was related to experiencing human loss and not having home insurance (Lee et al. 2009). ...
... Evidence of the convergence validity of the fear and distress variable is demonstrated by its strong association with PTSD (44,51). For each of the 4 chronic condition analytic samples considered in this study, those who reported a lot of fear and distress were significantly more likely to meet criteria (52) for PTSD at significance levels of p < .01. We did not consider PTSD in this study due to insufficient power to detect associations with this variable. ...
Background and Objectives
Our understanding of the impact of disaster exposure on the physical health of older adults is largely based on hospital admissions for acute illnesses in the weeks following a disaster. Studies of longer-term outcomes have centered primarily on mental health. Missing have been studies examining whether exposure to disaster increases the risk for the onset of chronic diseases. We examined the extent to which 2 indicators of disaster exposure (geographic exposure and peritraumatic stress) were associated with new onset of cardiovascular disease, diabetes, arthritis, and lung disease to improve our understanding of the long-term physical health consequences of disaster exposure.
Research Design and Methods
We linked self-reported data collected prior to and following Hurricane Sandy from a longitudinal panel study with Medicare data to assess time to new onset of chronic diseases in the 4 years after the hurricane.
Results
We found that older adults who reported high levels of peritraumatic stress from Hurricane Sandy had more than twice the risk of experiencing a new diagnosis of lung disease, diabetes, and arthritis in the 4 years after the hurricane compared to older adults who did not experience high levels of peritraumatic stress. Geographic proximity to the hurricane was not associated with these outcomes. Analyses controlled for known risk factors for the onset of chronic diseases, including demographic, psychosocial, and health risks.
Discussion and Implications
Findings reveal that physical health effects of disaster-related peritraumatic stress extend beyond the weeks and months after a disaster and include new onset of chronic diseases that are associated with loss of functioning and early mortality.
... Mode of virus transmission is animal to human and human to animals with incubation period of 5-6 days 10 . Clinical presentation of virus infection is different and varies from asymptomatic to mild upper respiratory infection and severe viral pneumonia consists of respiratory failure and ultimately leading to death 11 . ...
Background: COVID-19 is a wide spreading disease starts from Wuhan a city of China in east. Earlier symptoms include fever, cough and fatigue later on patients may present with loss of smell and taste, sore throat, nasal congestion and muscle or joint pain. Its long term effects may include respiratory distress and neurological symptoms. Aim: To determine the frequency of different symptoms in patients with COVID-19 presenting at outpatients department of Nishtar Hospital Multan. Methodology: This cross sectional study was conducted at department of medicine, Nishtar Medical University, Multan, from September 2020 to September 2021. This study was carried out on 200 patients presenting with symptoms of COVID-19 and diagnosis was confirmed after admission. Main variables of study were symptoms of COVID-19 like cough, fever, running nose, breathlessness, headache and palpitations. SPSS version 22 was used for data analysis. Results: Majority of the patients were (60.0%) between age group 46-60 years. The most common symptoms were fever and cough, (79.0%) and (65.0%), respectively. The symptoms recorded between both male and female were almost equal, (standardized residuals<1.96 and p>0.05). But, fever and running nose were most common among the females, (p=0.028) and (p=0.050), respectively. Conclusion: COVID-19 presents with variety of symptoms and fever and cough were most common among these symptoms. COVID-19 positive patients can be present asymptomatically. All persons who come into contact with COVID19 patients should be go through the PCR lab test. Keywords: Novel COVID 19, Acute Respiratory Distress Syndrome, Contagious, Pandemic
... Social policies including building houses, roads, and river barriers are essential for disaster-prone residents of rural and remote communities. Older disaster victims are more at risk of negative health outcomes, evidenced by low social support, economic dependency, re-experiencing disasters, pre-existing chronic health conditions, and feelings of distress during a disaster [30,33,34,39,57]. Emotional support is identified as an important factor for promoting the health of elderly disaster victims [58]. ...
1) Background: Following natural disasters, women have a higher prevalence of adverse physical and mental health outcomes. Given that the South and Southeast Asia regions are highly disaster prone, a review was undertaken to identify the potential health impact and key risk factors affecting women after disasters in the countries located in South and Southeast Asia regions. (2) Methods: A systematic literature search of four databases yielded 16 studies meeting the inclusion criteria. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance, between July 2008 and March 2021. (3) Results: The majority of studies reported women's negative/poor mental health, identifying a significant association of socio-demographics, during disaster exposure, post-disaster, and pre-existing risk factors. The six most-cited influences on women's mental health found in the reviewed literature were being female, adult age group, having no formal education, poverty or low economic status, poor physical health/physical injuries, and death of family members. Women's health during the post-disaster period was generally reported as poor among all the countries of the South and Southeast Asia regions. (4) Conclusion: Appropriate social support and the availability of free healthcare access for women are warranted in disaster-affected areas. This review offers a valuable contribution to the knowledge of women's health complications/challenges and associated risk factors related to disasters , essential for the development of strategies to help reduce this burden in the future. Further research is required on natural disasters to identify ways to reduce women's health impacts after natural disasters, especially in the context of low-income and lower-middle-income countries.
... Altruistic behaviours also lead to positive collective outcomes, such as an increase in opportunities for social relationships, solidarity, reciprocal support and feelings of being a competent individual and community member (Drury, 2018;Vezzali, Drury, Versari, & Cadamuro, 2016). These are critical elements upon which community resilience is built (Heid, Christman, Pruchno, Cartwright, & Wilson-Genderson, 2016;Norris, Stevens, Pfefferbaum, Wyche, & Pfefferbaum, 2008). Therefore, the adoption of prosocial behaviours by community members is also supposed to foster greater perceptions of the community's ability to cope under difficult circumstances (i.e., its resilience or capability to respond to negative collective events and stressors) (Magis, 2010). ...
We aimed to identify the patterns of prosocial behaviours under collective quarantine conditions. Survey data were collected from a sample of Italian adults during the March May 2020 COVID-19 lockdown in Italy. Participants reported on offline and online prosocial behaviours, sense of community responsibility (SoC-R) and perceptions of community resilience. Latent class analysis (LCA) was used for data analysis. A total of 4,045 participants completed the survey, and 2,562 were eligible (72% female; mean age 38.7 years). LCA revealed four classes of prosocial behaviours: Money donors (7%), Online and offline helpers (59%), Online health information sharers (21%) and Neighbour helpers (13%). The classes were partially invariant across age groups (18-35 and 35-65 years). Being a man, having achieved a higher educational level and higher SoC-R scores were associated with belonging to the Online and offline helper class. The members of this class also reported the greatest perceptions of community resilience. The results provide insight on the multidimensionality of prosociality under collective quarantine conditions. Online and offline helpers could be targeted for promoting sustained altruism and involvement in community organisations. For the other groups, programmes should aim at eliminating barriers to help others in multiple ways. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.
... Altruistic behaviours also lead to positive collective outcomes, such as an increase of opportunities for social relationships, solidarity, reciprocal support, and feelings of being a competent individual and community member (Drury, 2018;Vezzali, Drury, Versari, & Cadamuro, 2016). These are critical elements upon which community resilience is built (Heid, Christman, Pruchno, Cartwright, & Wilson-Genderson, 2016;Norris, Stevens, Pfefferbaum, Wyche, & Pfefferbaum, 2008). Therefore, the adoption of prosocial behaviours by community members is also supposed to foster greater perceptions of the community' b y cope under difficult circumstances (i.e., its resilience or capability to respond to negative collective events and stressors) (Magis, 2010). ...
Aim. To identify patterns of prosocial behaviours under collective quarantine conditions.Method. Survey data was collected from a sample of Italian adults during the March ̶ May 2020 COVID-19 lockdown in Italy. Participants reported on offline and online prosocial behaviours, Sense of Community Responsibility (SoC-R) and perceptions of community resilience. Latent class analysis (LCA) was used for data analysis.Results. A total of 4,045 participants completed the survey and 2,562 were eligible (72% female; mean age 38.7 years). LCA revealed four classes of prosocial behaviours: Money donors (7%), Online & offline helpers (59%), Online health information sharers (21%), and Neighbour helpers (13%). The classes were partially invariant across age groups (18 ̶ 35 and > 35 years). Being a man and higher SoC-R scores were associated with belonging to the Online & offline helper class. Members of this class also reported the greatest perceptions of community resilience.Conclusions. Results offer insight on the multidimensionality of prosociality under collective quarantine conditions. Online & offline helpers could be targeted for promoting sustained altruism and involvement in community organisations. For the other groups, programmes should aim to eliminate barriers to help others in multiple ways.
... A prospective study found that the persistence of depressive symptoms following the 2008 recession magnified the negative impact of Hurricane Sandy, but the recession alone did not seem to impact depressive symptoms following Hurricane Sandy (Mandavia & Bonanno, 2019). In a different study, pre-existing chronic health conditions and feelings of distress during Hurricane Sandy independently predicted PTSD group membership (Heid, Christman, Pruchno, Cartwright, & Wilson-Genderson, 2016).Individuals with a history of anxiety disorders had a higher odd of developing PTSD and GAD 18 months after the major wildfire in Fort McMurray (Moosavi et al., 2019). Similarly, La Greca et al. (1998), found that children' pre-disaster levels of anxiety, inattention, and academic difficulties predicted greater PTSD symptoms three months after Hurricane Andrew. ...
In the past two decades, climate change-related natural disasters, such as hurricanes, floods, and droughts have become increasingly frequent and severe, impacting the emotional and psychological well-being of those who are directly or indirectly exposed to them. Despite great interest in understanding differences in anxiety and resilience in response to natural disasters, enthusiasm appears to outstrip empirical clarity, as there remains considerable ambiguity as to determinants of resilient or pathological outcomes following exposure to natural disasters. In addition, there are several major methodological limitations in climate change and related natural disaster research, including the use of univariate analyses, cross-sectional design, and retrospective measures. Keeping these limitations in mind, we first review literature examining the mental health outcomes of natural disasters. Findings suggest that, overall, resilience is more common than pathological outcomes. Second, we use a multi-dimensional framework of resilience to selectively review factors at the event, individual, as well as family and community levels that could help inform resilient or pathological outcomes. Finally, we consider key limitations and future directions for research and practice in the field of anxiety and resilience in response to climate disasters.
... The mental health of survivors of a traumatic event, such as a natural disaster, has been extensively studied. 22 However, owing to the lack of predisaster information, very few studies have been able to tease out the consequences of disaster exposure from preexisting conditions. In this study, we examined the community-level prevalence of mental health disorders as well as the within-individual trajectories of depressive symptoms and PTSS following the 2011 Great East Japan earthquake and tsunami. ...
Importance
Posttraumatic stress symptoms (PTSS) and depressive symptoms are common among survivors of a major disaster, yet few longitudinal studies have documented their long-term persistence at the community level.
Objective
To examine the trajectories of PTSS and depressive symptoms for as long as 5.5 years after the 2011 Great East Japan earthquake and tsunami.
Design, Setting, and Participants
This cohort study used data from 2781 participants in 3 waves of the Iwanuma Study (2010, 2013, and 2016), a cohort of community-dwelling older adults (≥65 years in August 2010) in Iwanuma, Japan, who were directly affected by the 2011 disaster. The baseline assessment of mental health predated the disaster by 7 months, and survivors were followed up for 5.5 years after the disaster. Data analysis was performed from October 2019 to February 2020.
Exposures
The March 11, 2011, Great East Japan earthquake and tsunami.
Main Outcomes and Measures
PTSS were measured by 9 questions on the Screening Questionnaire for Disaster Mental Health, while depressive symptoms were measured by 15 items on the Geriatric Depression Scale short form.
Results
The analytic samples for trajectories of PTSS and depressive symptoms included 2275 and 1735 respondents, respectively. In the study population at baseline, there were slightly more women (1262 of 2275 [55.5%] and 882 of 1735 [50.8%]), and most participants were aged 65 to 74 years (1533 [67.4%] and 1224 [70.5%]) and married (1664 [76.2%] and 1319 [77.7%]). Overall, there was a 13.6% (95% CI, 11.7%-15.6%) incidence of depression among individuals who did not have depression before the disaster, while a further 11.1% (95% CI, 9.8%-12.4%) reported PTSS after the disaster. By 5.5 years of follow-up, approximately half of the survivors with new depressive symptoms in 2013 (85 of 168 [50.6%]) and PTSS (147 of 253 [58.1%]) had recovered. The prevalence of depression in the community remained remarkably stable (between 504 participants [29.0%] and 506 participants [29.2%]) comparing predisaster and postdisaster data.
Conclusions and Relevance
In this study, mental illness symptoms persisted for more than 5 years among half of disaster survivors, but the community-wide prevalence of depression remained stable, suggesting that the community itself was resilient.
... At the community level, resilient outcomes are more likely to occur in communities with higher social cohesion (Heid, Christman, Pruchno, Cartwright, & Wilson-Genderson, 2016), lower crime rates (Mandavia & Bonanno, 2019), and less disaster exposure (Gruebner et al., 2016). Other important factors include the possible negative impact of health disparities such as access to health care and socioeconomic status on fear and anxiety. ...
Amid the global outbreak of COVID-19, resilience is likely to be one of the many possible outcomes. Studies pertaining to resilience following potentially traumatic events including disease outbreak have shown that the vast majority of individuals are resilient, and that outcomes depend on a combination of resilience factors including exposure severity, individual differences, family context, and community characteristics. To better understand psychological dysfunction and resilience during the global outbreak of COVID-19, researchers are encouraged to investigate long-term patterns of mental health rather than cross-sectional prevalence rates, adopt prospective designs and analyses, integrate multiple risk and resilience factors to enhance outcome prediction, and consider the importance of flexibility as the situation unfolds.
... 12 The first and most immediate strategy is to identify those who are at increased risk for developing PTSD after such a natural disaster (eg, those with chronic health conditions and emotional stress) before the disaster occurs and to target support and resource programs to mitigate the PTSD and other mental health issues, should they develop after the natural disaster like a pandemic. 13 Previous experience suggested that up to 30% of survivors of ARDS develop PTSD, with elderly patients with preexisting depression and low socioeconomic groups being the most severely affected. 9 In 1 report from Canada, PTSD was greater in health care workers associated with the SARS quarantine orders. ...
... Religious commitment or positive religious coping were positively correlated with posttraumatic growth in those exposed to disasters (Chan and Rhodes, 2013) and a conceptual posttraumatic growth model also included spiritual growth (Tedeschi and Calhoun, 2004). For self-rated health, its associations with depression and PTSD were widely reported among disaster-exposed people (Heid et al., 2016;Ruggiero et al., 2009). ...
Disasters have numerous harmful effects on the mental health status of trauma-exposed people. We investigated the differences in the association between trauma-related psychopathologies and posttraumatic growth according to the perceived social support level among victims of the Sewol Ferry disaster on April 16, 2014, in South Korea. Data from 241 bereaved family members, survivors, and family members of survivors were used. The Duke-UNC Functional Social Support Questionnaire, Posttraumatic Growth Inventory, PTSD Checklist-5, Posttraumatic Embitterment Disorder Self-Rating Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 were used to evaluate perceived social support, posttraumatic growth, and trauma-related psychopathologies. We found that the severity of depression and anxiety showed inverse correlations with posttraumatic growth only in the low-social support group, while they did not demonstrate significant correlations in the high-social support group. The social support level had correlations with posttraumatic growth and the severity of posttraumatic stress disorder and posttraumatic embitterment disorder only in female respondents. Furthermore, there was a mediation pathway from social support level to posttraumatic growth through depressive symptoms. This study explored the complex relationship between social support, posttraumatic growth, trauma-related psychopathologies, and gender among trauma-exposed individuals in the aftermath of the Sewol Ferry disaster.
... In fact, Schwartz et al. (2016) found that older people were less likely to report distress following a hurricane and Bonanno, Galea, Bucciarelli, and Vlahov (2007) found that people aged 65 and older were three times as likely to be resilient in the aftermath of the September 11 attacks as people between the ages of 18 and 24. On the other hand, it may be that older people, especially those with chronic illnesses and few resources, are more vulnerable in the face of disaster ( Heid et al., 2016). However, because few disaster studies have included older people (only one of the 31 studies included in Tang et al.'s 2014 meta-analysis included people aged 60 and older), the effects that disasters have on older people remains unknown. ...
Rationale:
Natural disasters have the potential to change the lives of older people, yet most studies rely on small convenience samples, few include assessments of people prior to the disaster, and only a handful examine the effects of different types of exposure.
Objective:
Our analyses add new knowledge to the literature by examining the ways in which four types of exposure (i.e., geographic, peri-traumatic stress, personal and property loss, and post-storm hardship) affect depressive symptoms experienced by older people over a five-year period.
Method:
We analyzed four waves of data from the ORANJ BOWL panel using multilevel mixed effects models.
Results:
We found that although each type of exposure had an independent effect on depressive symptoms, the effects of peri-traumatic stress were dominant.
Conclusions:
As nearly 20% of people in the United States will experience a natural disaster during the course of their lives, it is critical to understand how disaster exposure can influence mental health because each type of exposure demands a different response. Finding that an individual's emotional response during the disaster plays an important role in the development of depressive symptoms suggests that reduction of exposure to traumatic stress during a storm (i.e., evacuation from a storm area) is important for older people. Likewise, immediate interventions following a disaster that target people experiencing high levels of peri-traumatic distress may be particularly effective and that failing to attend to these people may miss a critical opportunity and result in years of suffering.
... Older adults with chronic illness and disabilities are particularly vulnerable to poor physical and mental health outcomes after a natural disaster. 1 Despite their known vulnerability, little research evidence exists regarding older adults' health care utilization during the year after a natural disaster. ...
Objective
To determine whether self-reports of disaster-related psychological distress predict older adults’ health care utilization during the year after Hurricane Sandy, which hit New Jersey on October 29, 2012.
Methods
Respondents were from the ORANJ BOWL Study, a random-digit dialed sample from New Jersey recruited from 2006 to 2008. Medicare hospital, emergency department (ED) and outpatient claims data from 2012 and 2013 were matched to 1607 people age 65 and older in 2012 who responded to follow-up surveys conducted from July 2013 to July 2015 to determine their hurricane-related experiences.
Results
In total, 7% (107) of respondents reported they experienced a lot versus 93% (1493) respondents reported they experienced little or no fear and distress from Hurricane Sandy. Those who experienced a lot versus little or no fear and distress had higher probability of all-cause hospital admissions and more ED visits through 3 months (hazard ratio [HR]: 2.19, 95% CI: 1.03-4.63; incidence ratio [IR]: 2.57, 95% CI: 1.21-5.35), and ED and outpatient visits (IR: 2.20, 95% CI: 1.44-3.37; IR: 1.37, 95% CI: 1.02-1.87) through the year after the hurricane.
Conclusions
A self-reported assessment of disaster-related psychological distress is a strong predictor of older adults’ health care needs the year after the disaster. The results indicate that disaster preparedness should extend beyond acute health care needs to address longer-term health consequences of disasters. ( Disaster Med Public Health Preparedness . 2018;page 1 of 4)
... Certain populations are believed to be at increased risk of negative mental health symptoms after a disaster. After Hurricane Sandy, older adults were reported to be especially vulnerable, particularly if they lacked social support [13,14]. Additionally, research suggests that women and individuals who have a history of trauma, including experience coping with previous hurricanes and 9 /11, may be at an increased risk of PTSD symptoms [6,15,16]. ...
Hurricane Sandy hit the eastern coast of the United States in October 2012, causing billions of dollars in damage and acute physical and mental health problems. The long-term mental health consequences of the storm and their predictors have not been studied. New York City and Long Island residents completed questionnaires regarding their initial Hurricane Sandy exposure and mental health symptoms at baseline and 1 year later (N = 130). There were statistically significant decreases in anxiety scores (mean difference = −0.33, p < 0.01) and post-traumatic stress disorder (PTSD) scores (mean difference = −1.98, p = 0.001) between baseline and follow-up. Experiencing a combination of personal and property damage was positively associated with long-term PTSD symptoms (ORadj 1.2, 95% CI [1.1–1.4]) but not with anxiety or depression. Having anxiety, depression, or PTSD at baseline was a significant predictor of persistent anxiety (ORadj 2.8 95% CI [1.1–6.8], depression (ORadj 7.4 95% CI [2.3–24.1) and PTSD (ORadj 4.1 95% CI [1.1–14.6]) at follow-up. Exposure to Hurricane Sandy has an impact on PTSD symptoms that persists over time. Given the likelihood of more frequent and intense hurricanes due to climate change, future hurricane recovery efforts must consider the long-term effects of hurricane exposure on mental health, especially on PTSD, when providing appropriate assistance and treatment.
... ORANJ BOWL participants were well dispersed throughout the state (Cromley, Wilson-Genderson, Christman, & Pruchno, 2015), residing in 1,644 of New Jersey's 1,912 census tracts with 10% of the sample (n = 604) residing in the coastal regions hardest hit by Hurricane Sandy (D. Abramson, personal communication, October 2015). Others lived inland, but were still affected by high winds and rain that resulted in distress and/or outcomes such as home damage (Heid, Christman, Pruchno, Cartwright, & Wilson-Genderson, 2016;. ...
Objective
Positing that successful aging (SA) has independent, yet related components that are both objective and subjective, we examine how the indicators of SA change over time and how exposure to a disaster affects the developmental course of SA.
Method
Data were gathered from 5,688 people aged 50–74 years living in New Jersey who participated in baseline telephone interviews between 2006 and 2008 and then were reassessed up to four times over the following 9 years. Multilevel mixed effects models were used to examine change in objective and subjective SA over time and to evaluate the impact of Hurricane Sandy on SA.
Results
Over the 9-year period, controlling for age, gender, education, and income, average levels of both subjective SA and objective SA declined. People exposed to Hurricane Sandy experienced sharper declines in subjective SA and indicators of objective SA (pain and functional ability) than people not exposed.
Discussion
Findings have important implications for expanding our conceptualization of SA, clarifying the measures used to understand SA, and the importance of accounting for the effects of disasters on SA.
The increasing frequency and severity of hurricanes induced by climate change, heighten the importance of understanding the emergency preparedness and needs of older adults with disabilities. This segment of the population faces an elevated risk of injury or death in hurricanes and other weather‐related emergencies, but little is known about their preparation for and evacuation intentions regarding such emergencies. Even less is known about communities' readiness to address older adults with disabilities' needs during emergencies. We examine hurricane readiness at the individual level using data from an online survey of Floridians aged 50 and older ( n = 3918) and at the county level using administrative data from 65 of Florida's 67 counties. Results of individual‐level analyses revealed that older adults with self‐reported mobility or vision impairments had lower odds of being hurricane prepared, suggesting they may have unmet needs in such emergencies. Results of county‐level analyses yielded mixed results. Although counties with higher proportions of their residents having limited abilities tended to have more special needs emergency shelters, counties with higher proportions of their residents using special equipment tended to have fewer—rather than more—such shelters. Our study provides insight that can inform policies aimed at safeguarding older adults with disabilities from the risks posed by the warming planet's intensifying storms.
Práca na diaľku alebo práca z domu je spôsob, ktorý poznáme už dlhšiu dobu. Súčasná pandémia Covid 19 však tento spôsob práce o čosi viac zviditeľnila a sprostredkovala oveľa väčšiemu množstvu ľudí, ako tomu bolo v minulosti. Reakcie na takýto spôsob práce sa rôznia, od pracovníkov, ktorí tento spôsob privítali, až po reakcie na opačnom konci spektra, ktorí pociťujú rôzne typy praktických, či psychologických ťažkostí. Rôznym súvislostiam, vrátane tých psychologických sa venujú súčasné prieskumy a výskumy. Príspevok prezentuje vybrané poznatky o vnímaných výhodách a nevýhodách a faktoroch ovplyvňujúcich spokojnosť a postoje k práci z domu/ vzdialenej práci. Na záver ponúka zopár implikácií, ako prácu z domu/ vzdialenú prácu uchopiť efektívnejšie.
Working remotely or working from home (homeoffice) is a way of work we have known for a longer time. However, the current Covid 19 pandemic has made this way of working somewhat more visible and accessible to a much larger number of eployees and enterpreneurs than in the past. Reactions to this way of work vary, from workers who have welcomed this way to reactions at the other end of the spectrum who experience several practical or psychological di culties. This paper is focused on various contexts of remote work, including psychological ones. The paper introduces selected ndings and factors in uencing satisfaction and attitudes towards work from home / remote work. Finally, it o ers a few implications of how to handle work from home / remote work more e ectively.
Continual rise of overweight and obesity of the world‘s population represents a serious global health problem. In addition to physical health, obesity signi cantly a ects overall quality of life, well-being, mental state and social functioning. Current article deals mainly with the psychological and behavioral aspects of overweight and obesity and presents opportunities for psychological interventions.
Globally, an increasing and more dispersed population, as well as climate change, have led to growing impacts of environmental hazards, particularly across areas prone to extreme weather events such as tropical cyclones. Tropical cyclones frequently cause fatalities, damage to infrastructure, and disruption to economic activities. The north and northeast regions of Oman, particularly the Oman seacoast, are prone to the storm surges, windstorms and extreme precipitation events associated with these tropical storms. However, integrated spatial risk assessments, for the purpose of mapping cyclone risk at subnational geographic scales, have not yet been developed in this area. Here we evaluate and map cyclone risk using four independent components of risk: hazard, exposure, vulnerability and mitigation capacity. An integrated risk index was calculated using a geographical information system (GIS) and an analytical hierarchical process (AHP) technique, based on a geodatabase including 17 variables (i.e., GIS data layers) and criteria, with rank and weight scores for each criterion. The resulting risk assessment reveals the spatial variation in cyclone risk across the study area and highlights how this variation is controlled by variations in physical hazard, exposure, vulnerability and emergency preparedness. The risk maps reveal that, despite their perceived adaptive capacity for disaster mitigation, the population and assets in low-lying lands situated near the coastline in the east of Muscat, as well as the Al-Batnah south governorates, are at high risk due to cyclones. Furthermore, the coastal zones of the urban Wilayats of the Muscat governorate were also found to be at high, to very high, risk. This study has several policy implications and can provide effective guidelines for natural hazard preparedness and mitigation across the northern coasts of Oman.
Objective
The Society of Academic Emergency Medicine Disaster Medicine Interest Group, the Office of the Assistant Secretary for Preparedness and Response – Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) team, and the National Institutes of Health Library searched disaster medicine peer-reviewed and gray literature to identify, review, and disseminate the most important new research in this field for academics and practitioners.
Methods
MEDLINE/PubMed and Scopus databases were searched with key words. Additional gray literature and focused hand search were performed. A Level I review of titles and abstracts with inclusion criteria of disaster medicine, health care system, and disaster type concepts was performed. Eight reviewers performed Level II full-text review and formal scoring for overall quality, impact, clarity, and importance, with scoring ranging from 0 to 20. Reviewers summarized and critiqued articles scoring 16.5 and above.
Results
Articles totaling 1176 were identified, and 347 were screened in a Level II review. Of these, 193 (56%) were Original Research, 117 (34%) Case Report or other, and 37 (11%) were Review/Meta-Analysis. The average final score after a Level II review was 11.34. Eighteen articles scored 16.5 or higher. Of the 18 articles, 9 (50%) were Case Report or other, 7 (39%) were Original Research, and 2 (11%) were Review/Meta-Analysis.
Conclusions
This first review highlighted the breadth of disaster medicine, including emerging infectious disease outbreaks, terror attacks, and natural disasters. We hope this review becomes an annual source of actionable, pertinent literature for the emerging field of disaster medicine.
An earthquake is a very common natural disaster. Numerous studies have focused on the acute phase, but studies concerning the subacute phase after an earthquake were very limited. This aroused more attention being paid to medical relief in the subacute phase, and this study elaborated on the division of the medical relief period and the definition of medical relief targets. More importantly, major types of disease were analyzed by reviewing the relevant published studies, which were identified by searching electronic databases. Findings suggested that the clear division of medical relief stage is vital for determining the priority of medical aid and allocating medical resources scientifically, and all concerned populations should be targeted for medical assistance. The focus of acute phase is injury (64.2%), and the subacute phase is disease (27.8% respiratory disease, 22.9% common disease, 12.5% wound/injury, 10.5% skin disease, 8.7% gynecological and pediatric disease, 8.5% digestive disease). However, due to the limited available studies, the included articles perhaps did not reflect the actual proportion of each type of disease. More studies are needed to better understand the proportion of different diseases in each phase of an earthquake.
Objective
To determine whether there were incremental mental health impacts, specifically on depression trajectories, as a result of the 2008 economic crisis (the Great Recession) and subsequent Hurricane Sandy.
Method
Using latent growth mixture modeling and the ORANJ BOWL dataset, we examined prospective trajectories of depression among older adults (mean age, 60.67; SD, 6.86) who were exposed to the 2 events. We also collected community economic and criminal justice data to examine their impact upon depression trajectories. Participants (N=1172) were assessed at 3 times for affect, successful aging, and symptoms of depression. We additionally assessed posttraumatic stress disorder (PTSD) symptomology after Hurricane Sandy.
Results
We identified 3 prospective trajectories of depression. The majority (83.6%) had no significant change in depression from before to after these events (resilience), while 7.2% of the sample increased in depression incrementally after each event (incremental depression). A third group (9.2%) went from high to low depression symptomology following the 2 events (depressive-improving). Only those in the incremental depression group had significant PTSD symptoms following Hurricane Sandy.
Conclusion
We identified a small group of individuals for whom the experience of multiple stressful events had an incremental negative effect on mental health outcomes. These results highlight the importance of understanding the perseveration of depression symptomology from one event to another. ( Disaster Med Public Health Preparedness . 2018;page 1 of 10)
Objectives:
Older adults exposed to natural disasters are at risk for negative psychological outcomes such as post-traumatic stress disorder (PTSD). Neighborhood social capital can act as a resource that supports individual-level coping with stressors. This study explores the ability of perceived neighborhood collective efficacy, a form of social capital, to moderate the association between exposure to Hurricane Sandy and PTSD symptoms in older adults.
Method:
Data from 2205 older individuals aged 54-80 residing in New Jersey who self-reported exposure to Hurricane Sandy in October of 2012 were identified and extracted from the ORANJ BOWL™ research panel. Participants completed baseline assessments of demographic and individual-level characteristics in 2006-2008 and follow-up assessments about storm exposure, perceived neighborhood collective efficacy (social cohesion and social control), and PTSD symptoms 8-33 months following the storm. Zero-inflated Poisson regression models were tested to examine the association between exposure, neighborhood collective efficacy, and PTSD symptoms.
Results:
After accounting for known demographic and individual-level covariates, greater storm exposure was linked to higher levels of PTSD symptoms. Social cohesion, but not social control, was linked to lower reports of PTSD symptoms and moderated the association between exposure and PTSD. The impact of storm exposure on PTSD symptoms was less for individuals reporting higher levels of social cohesion.
Conclusion:
Mental health service providers and disaster preparedness and response teams should consider the larger social network of individuals served. Building social connections in older adults' neighborhoods that promote cohesion can reduce the negative psychological impact of a disaster.
Objectives:
Older adults exposed to natural disasters are at risk for negative psychological outcomes such as post-traumatic stress disorder (PTSD). Neighborhood social capital can act as a resource that supports individual-level coping with stressors. This study explores the ability of perceived neighborhood collective efficacy, a form of social capital, to moderate the association between exposure to Hurricane Sandy and PTSD symptoms in older adults.
Method:
Data from 2205 older individuals aged 54-80 residing in New Jersey who self-reported exposure to Hurricane Sandy in October of 2012 were identified and extracted from the ORANJ BOWL™ research panel. Participants completed baseline assessments of demographic and individual-level characteristics in 2006-2008 and follow-up assessments about storm exposure, perceived neighborhood collective efficacy (social cohesion and social control), and PTSD symptoms 8-33 months following the storm. Zero-inflated Poisson regression models were tested to examine the association between exposure, neighborhood collective efficacy, and PTSD symptoms.
Results:
After accounting for known demographic and individual-level covariates, greater storm exposure was linked to higher levels of PTSD symptoms. Social cohesion, but not social control, was linked to lower reports of PTSD symptoms and moderated the association between exposure and PTSD. The impact of storm exposure on PTSD symptoms was less for individuals reporting higher levels of social cohesion.
Conclusion:
Mental health service providers and disaster preparedness and response teams should consider the larger social network of individuals served. Building social connections in older adults' neighborhoods that promote cohesion can reduce the negative psychological impact of a disaster.
Although evidence is rapidly amassing as to the damaging potential of early life adversities on physical and mental health, as yet few investigations provide comparative snapshots of these patterns across adulthood. This population-based study addresses this gap, examining the relationship of adverse childhood experiences (ACEs) to physical and mental health within a representative sample (n = 19,333) of adults, comparing the prevalence and explanatory strength of ACEs among four birth cohorts spanning ages 18-79. This assessment accounts for demographic and socioeconomic factors, as well as both direct and moderating effects of resilience resources (social/emotional support, life satisfaction, and sleep quality). Findings demonstrate (1) increasing trends of reported ACEs across younger cohorts, including time period shifts such as more prevalent family incarceration, substance abuse, and divorce, (2) significant bivariate as well as independent associations of ACEs with poor health within every cohort, controlling for multiple covariates (increasing trends in older age for physical health), and (3) robust patterns wherein resilience resources moderated ACEs, indicating buffering pathways that sustained into old age. Theoretical and practice implications for health professionals are discussed.
Recent empirical and theoretical research has questioned whether fear, helplessness, and horror sufficiently cover the emotional responses that may lead to posttraumatic stress disorder (PTSD; Lee, Scragg, & Wilson, 2001). Instead of relying on these three emotions, the possibility exists in which other emotional experiences at the time of traumatic events could predict PTSD symptom level. The current study examined retrospectively reported emotional experiences in relation to current level of PTSD symptoms in a diverse sample. Additional analyses examined the possibility that differences in emotional predictors of symptom level may exist across gender and ethnicity. Results indicated that although fear, helplessness, and horror were not significant predictors of PTSD symptom level, anger consistently emerged as a predictor. Results also demonstrated differences based on gender and ethnicity. These findings are briefly discussed in terms of their research and clinical implications. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Few research studies have addressed the long-term effects caused by catastrophes, and no study has ever explored the life quality, physical diseases, and psychological impairment of earthquake survivors at the same time. This study seeks to reveal survivors' quality of life, physical diseases, and mental health.
A cross-sectional survey was conducted through multi-stage sampling approach three years after the Wenchuan earthquake.
A total of 2525 subjects were interviewed. Symptoms of PTSD were reported by 8.8% of the respondents from the seriously affected areas and 0.5%, the less hit areas. Prevalence of chronic diseases was 39.2% and 22.1% respectively, and two-week prevalence rate, 24.9% and 12.7% respectively. In the multivariate analysis, two-week prevalence, displacement, no regular income, receiving mental health support after the disaster, family members died or missing, injured due to the quake, and person who witnessed someone being killed or injured were independently associated with higher prevalence for symptoms of PTSD. Most subscales of SF-12 negatively correlated with age, chronic diseases, two-week prevalence, injured due to the disaster, home or property loss, and score of the 3-year PTSD symptoms, but positively correlated with higher education and higher household income.
The rates of physical diseases and symptoms of PTSD were relatively high, and the quality of life was poor among victims in the hard-hit areas 3 years after the earthquake. Physical impairment correlated with symptom of PTSD, and both were negatively associated with quality of life.
Objective: Older adults report fewer posttraumatic stress disorder (PTSD) symptoms than younger adults, but the reasons for this age difference are unclear. In the current study, the authors explored the extent to which they may be due to age differences in event centrality (the extent to which a person construes a stressful event as central to their identity). Method: A sample of older and younger adults nominated their most stressful event and completed measures of PTSD symptoms and event centrality. Results: The results revealed that older adults were less likely to construe a stressful event as central to identity, even after controlling for type of event, how long ago the event occurred, and gender. In addition, the results of a mediation analysis indicated that age-related differences in event centrality partially mediated age-related differences in PTSD symptoms. Discussion: The results are consistent with the Socioemotional Selectivity Theory view that older adults tend to use cognitive strategies designed to protect emotional health.
Posttraumatic stress disorder (PTSD) is a common and disabling condition following a traumatic event. Despite its high prevalence rates, relatively little is known about the manifestation and course of the disorder in older adults. Moreover, there has been little evaluation of the efficacy of psychotherapeutic treatment approaches for older patients.
This overview aims to summarize available data on the prevalence and symptoms of late-life PTSD and to review the current treatment approaches for older adults.
The course and severity of PTSD symptoms in older adults depend on the time the trauma occurred (early versus late life). In the case of acute traumatization, lower prevalence rates and symptom severities are generally observed in older than in younger populations. In the case of early-life traumatization, a decline in PTSD symptom severity can be observed over the life course. Research on treatment approaches has produced promising results, indicating that disorder-specific interventions (i.e., trauma confrontation and cognitive restructuring) can be effectively combined with an age-specific narrative life-review approach.
Given the limited empirical evidence, caution is warranted in generalizing the reported findings. Nevertheless, it is possible to draw a number of conclusions concerning the characteristics and treatment of PTSD in older adults. Further research is needed to better understand the various presentations of PTSD in late life and to validate and improve the effectiveness of available treatment approaches.
To propose and test a conceptual two-factor model of successful aging that includes objective and subjective components.
Data were derived from 5,688 persons aged 50-74 years living in New Jersey who participated in the ORANJ BOWL panel. Participants were recruited using random digit dial procedures and interviewed by telephone. A measurement model was developed and tested using data from two independent samples (each n = 1,000); a structural model examining the effects of age and gender was tested using data from another 3,688 people.
Confirmatory factor analyses provided support for a multidimensional model incorporating objective criteria and subjective perceptions. Age and gender were associated with objective but not subjective success.
Results add rigor to the measurement of a construct that has intrigued philosophers and scientists for hundreds of years, providing the empirical foundation on which to build research about successful aging.
To determine if baseline functional health status, as measured by SF-36 (veterans), predicts new onset symptoms or diagnosis of post-traumatic stress disorder among deployed US military personnel with combat exposure.
Prospective cohort analysis.
Millennium Cohort.
Combat deployed members who completed baseline (2001-3) and follow-up (2004-6) questionnaires. Self reported and electronic data used to examine the relation between functional health and post-traumatic stress disorder.
New onset post-traumatic stress disorder as measured by either meeting the DSM-IV criteria with the 17 item post-traumatic stress disorder checklist-civilian version or self report of a physician diagnosis at follow-up with the absence of both at baseline.
Of the 5410 eligible participants, 395 (7.3%) had new onset symptoms or diagnosis of post-traumatic stress disorder at the time of follow-up. Individuals whose baseline mental or physical component summary scores were below the 15th centile had two to three times the risk of symptoms or a diagnosis of post-traumatic stress disorder by follow-up compared with those in the 15th to 85th centile. Of those with new onset symptoms or diagnosis of post-traumatic stress disorder, over half (58%) of cases occurred among participants with scores below the 15th centile at baseline.
Low mental or physical health status before combat exposure significantly increases the risk of symptoms or diagnosis of post-traumatic stress disorder after deployment. More vulnerable members of a population could be identified and benefit from interventions targeted to prevent new onset post-traumatic stress disorder.
Confirmatory factor analysis was used to test the structure of 5-item affect rating scales designed to measure positive affect and negative affect. A proposed circumplex affect structure was the source of scales constructed to represent a cluster of positive terms, including pleasantness and activation; the negative terms represented anxiety, depression, and hostility. The hypothesized simple-structured positive and negative trait affect factors, with a moderate correlation between them, were found in all cases. Equivalent structure was confirmed for younger adults, middle-aged, and older adults of good health and above-average education. Although the hypothesized simple-structured positive and negative factors emerged for all other groups, three other tests of factor equivalence failed to be confirmed: trait and state factors in the older adult group were not identical. Factors derived from healthy and frail elders were structurally different. Variability among frail elders and variability over 30 days within the same person, when factored, also showed nonequivalence. Although the scales are extremely useful in assessing affect, comparisons across some subject groups should be made with caution.
We derived and tested a short form of the Center for Epidemiologic Studies Depression Scale (CES-D) for reliability and validity among a sample of well older adults in a large Health Maintenance Organization. The 10-item screening questionnaire, the CESD-10, showed good predictive accuracy when compared to the full-length 20-item version of the CES-D (kappa = .97, P < .001). Cutoff scores for depressive symptoms were > or = 16 for the full-length questionnaire and > or = 10 for the 10-item version. We discuss other potential cutoff values. The CESD-10 showed an expected positive correlation with poorer health status scores (r = .37) and a strong negative correlation with positive affect (r = -.63). Retest correlations for the CESD-10 were comparable to those in other studies (r = .71). We administered the CESD-10 again after 12 months, and scores were stable with strong correlation of r = .59.
Results for 160 samples of disaster victims were coded as to sample type, disaster type, disaster location, outcomes and risk factors observed, and overall severity of impairment. In order of frequency, outcomes included specific psychological problems, nonspecific distress, health problems, chronic problems in living, resource loss, and problems specific to youth. Regression analyses showed that samples were more likely to be impaired if they were composed of youth rather than adults, were from developing rather than developed countries, or experienced mass violence (e.g., terrorism, shooting sprees) rather than natural or technological disasters. Most samples of rescue and recovery workers showed remarkable resilience. Within adult samples, more severe exposure, female gender, middle age, ethnic minority status, secondary stressors, prior psychiatric problems, and weak or deteriorating psychosocial resources most consistently increased the likelihood of adverse outcomes. Among youth, family factors were primary. Implications of the research for clinical practice and community intervention are discussed in a companion article (Norris, Friedman, and Watson, this volume).
This study evaluated the prevalence of posttraumatic stress disorder (PTSD) and the longitudinal course of early PTSD symptoms in survivors of terrorist attacks. It additionally assessed the effect of continuous terrorism on the course of early symptoms of PTSD.
Thirty-nine survivors of terrorist attacks and 354 survivors of motor vehicle accidents were evaluated upon admission to a general hospital emergency room and 1 week and 4 months later. Heart rate was measured upon admission to the emergency room. Peritraumatic dissociation was assessed at 1 week. PTSD symptoms, anxiety, and depression were measured at 1 week and 4 months. The Clinician-Administered PTSD Scale conferred a diagnosis of PTSD at 4 months. Additionally, the course of early PTSD symptoms during an era of frequent terrorist attacks (N=137) was compared with that seen during years of relative calm (N=256).
Survivors of terrorist attacks had higher rates of PTSD than motor vehicle accident survivors (37.8% versus 18.7%). The type of traumatic event, however, did not add to the prediction of PTSD from the emergency room heart rate, peritraumatic dissociation symptoms, and early PTSD symptoms. The longitudinal course of early PTSD symptoms was not affected by the greater frequency of terrorist attacks.
Early symptoms are reliable risk indicators of PTSD across events and circumstances. Converging effects of terror-induced fear, adjustment, and resiliency might explain the lack of effect of intense terrorism on the course of PTSD symptoms.
Background:
Traumatic exposure during a hurricane is associated with adverse mental health conditions post-event. The World Trade Center Health Registry provided a sampling pool for a rapid survey of persons directly affected by Hurricane Sandy in the New York City (NYC) metropolitan area in late October 2012. This study evaluated the relationship between Sandy experiences and Sandy-related posttraumatic stress disorder (PTSD) among individuals previously exposed to the September 11, 2001 (9/11) disaster.
Methods:
A total of 4,558 surveys were completed from April 10-November 7, 2013. After exclusions for missing data, the final sample included 2,214 (53.5%) respondents from FEMA-defined inundation zones and 1,923 (46.5%) from non-inundation zones. Sandy exposures included witnessing terrible events, Sandy-related injury, fearing for own life or safety of others, evacuation, living in a home that was flooded or damaged, property loss, and financial loss. Sandy-related PTSD was defined as a score of ≥44 on a Sandy-specific PTSD Checklist.
Results:
PTSD prevalence was higher in the inundation zones (11.3%) and lower in the non-inundation zones (4.4%). The highest prevalence of Sandy-related PTSD was among individuals in the inundation zone who sustained an injury (31.2%), reported a history of 9/11-related PTSD (28.8%), or had low social support prior to the event (28.6%). In the inundation zones, significantly elevated adjusted odds of Sandy-related PTSD were observed among persons with a prior history of 9/11-related PTSD, low social support, and those who experienced a greater number of Sandy traumatic events.
Conclusions:
Sandy-related stress symptoms indicative of PTSD affected a significant proportion of persons who lived in flooded areas of the NYC metropolitan area. Prior 9/11-related PTSD increased the likelihood of Sandy-related PTSD, while social support was protective. Public health preparation for events similar to Sandy should incorporate outreach and linkages to care for persons with prior disaster-related trauma.
In a population with prior exposure to the World Trade Center disaster, this study sought to determine the subsequent level of preparedness for a new disaster and how preparedness varied with population characteristics that are both disaster-related and non-disaster-related.
The sample included 4496 World Trade Center Health Registry enrollees who completed the Wave 3 (2011-2012) and Hurricane Sandy (2013) surveys. Participants were considered prepared if they reported possessing at least 7 of 8 standard preparedness items. Logistic regression was used to determine associations between preparedness and demographic and medical factors, 9/11-related post-traumatic stress disorder (PTSD) assessed at Wave 3, 9/11 exposure, and social support.
Over one-third (37.5%) of participants were prepared with 18.8% possessing all 8 items. The item most often missing was an evacuation plan (69.8%). Higher levels of social support were associated with being prepared. High levels of 9/11 exposure were associated with being prepared in both the PTSD and non-PTSD subgroups.
Our findings indicate that prior 9/11 exposure favorably impacted Hurricane Sandy preparedness. Future preparedness messaging should target people with low social support networks. Communications should include information on evacuation zones and where to find information about how to evacuate. (Disaster Med Public Health Preparedness. 2015;0:1-9).
High levels of prolonged grief symptoms (PGS) and posttraumatic stress symptoms (PTS) are relatively common following bereavement. The two types of bereavement complications share some but not all of the same features. Little research has studied which of the two precedes the other following the death of a loved one. The purpose of this study was to examine the temporal relationship between change in PGS and PTS during the first 4 years following old age spousal loss.
Participants were 237 Danes (40% male; mean age = 73 years, SD = 4.4; range 65-81) who during the year of 2006 lost their spouse. Participants completed self-report questionnaires at 6 months (n = 237), 13 months (n = 198), 18 months (n = 192), and 48 months (n = 213) post loss. Main outcome measures were Inventory of Complicated Grief-Revised and the Harvard Trauma Questionnaire.
Lower level mediation analyses were performed. Results indicated that PGS mediated 83% of the relationship between time and PTS, whereas PTS only mediated 17% of the relationship between time and PGS. These results suggest that changes in PGS mediated changes in PTS following spousal bereavement to a greater extent than vice versa.
The findings in the present study indicate that changes in PGS may precede and potentially directly impact changes in PTS following bereavement. This tentative conclusion points to the potential value of targeting PGS in psychological interventions at an early point in the long-term perspective following old age spousal bereavement.
© 2015 Wiley Periodicals, Inc.
To document the 6-month prevalence of posttraumatic stress syndrome (PTSS) in the older adult population and the validity of a PTSS Scale in an epidemiologic setting.
Data came from the Enquête sur la santé des aînés et l'utilisation des services de santé (ESA Services Study) conducted during 2012-2013 using a probability sample of older adults seeking medical services in primary health clinics.
Results showed that a first-order PTSS measurement model consisting of 3 indicators-the number of lifetime traumatic events, the frequency of reactions and symptoms of distress associated with the traumatic events, and the presence of consequences on the social functioning-was plausible. Reliability of the PTSS was 0.82. According to the PTSS, 11.1% of the older adult patients presented with PTSS, but only 21.7% of them reported an impact of their symptoms on their social functioning. The prevalence of older adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for full posttraumatic stress disorder (PTSD) reached 1.8%, and 1.8% of older adults reached criteria for partial PTSD. Our results also showed that women were more at risk to report PTSS than men and that older adults aged 75 years and older were less likely to report these symptoms than those aged between 65 and 74 years.
PTSS is a common mental health problem among adults aged 65 and older and seeking health services in the general medical sector.
Objective:
The present study tested the maturation and inoculation hypotheses by examining whether age and previous exposure to the September 11, 2001, World Trade Center (WTC) terrorist attack moderated the relationship between degree of exposure to Hurricane Sandy and related posttraumatic stress disorder (PTSD) symptoms.
Method:
An online sample of 1,000 participants from affected states completed self-report questionnaires one month after Hurricane Sandy hit the East Coast. Participants reported their degree of exposure to the WTC terrorist attack and to Hurricane Sandy, and their posttraumatic stress disorder (PTSD) symptoms following Hurricane Sandy.
Results:
The positive relationship between degree of exposure to Hurricane Sandy and level of PTSD symptoms was weaker among older adults. An additional significant three-way interaction suggested that both age and previous exposure to the WTC terrorist attack moderated the relationship between degree of exposure to Hurricane Sandy and level of PTSD symptoms. Previous high degree of exposure to the WTC terrorist attack was related to a weaker effect of current exposure to Hurricane Sandy on PTSD symptoms among older adults. However, among younger adults, previous high degree of exposure to the WTC terrorist attack was related to a stronger effect of current exposure on PTSD symptoms.
Conclusions:
When confronted by a natural disaster, American older adults are generally resilient. Supporting the inoculation hypothesis, resilience of older adults may be partly related to the strength successfully extracted from previous exposure to adverse events.
Importance:
Little is known about the association between posttraumatic stress disorder (PTSD) and disability into later life. Most studies of late-life psychiatric disorders and function have focused on depression and generalized anxiety disorder.
Objectives:
To determine the association between PTSD and disability among older adults and investigate if association differs by chronicity of PTSD.
Design, setting, and participants:
In total, 3287 participants 55 years and older (mean [SD] age, 66.0 [8.7] years, 60.1% women) involved in the Collaborative Psychiatric Epidemiology Surveys (2001-2003), including 3 aggregated, nationally representative studies (National Comorbidity Survey Replication, National Survey of American Life, and National Latino and Asian American Study). Analyses used weights and complex design-corrected statistical tests to infer generalizability to the US population.
Main outcomes and measures:
Disability defined by 5 domains (out of role, self-care, mobility, cognition, and social) using the World Health Organization Disability Assessment Schedule.
Results:
Of the 3.7% older adults who had a history of PTSD defined by DSM-IV criteria, 1.8% had persistent PTSD into later life (age of onset <55 years as well as a recent diagnosis). Frequency of any disability was 79.7% for persistent PTSD, 69.6% for pre-late life (age of onset <55 years and age at last diagnosis <55 years), and 36.9% for no PTSD (P < .001). In logistic regression analyses, adjusting for demographics, smoking, individual medical conditions, depression, generalized anxiety disorder, and substance use disorders, respondents with persistent PTSD were 3 times more likely to have any disability than were respondents with no PTSD (odds ratio, 3.18; 95% CI, 1.32-7.64). Global disability results were nonsignificant for pre-late life relative to no PTSD (odds ratio, 1.99; 95% CI, 0.97-4.08).
Conclusions and relevance:
Disability in older Americans is strongly associated with PTSD, particularly PTSD that persists into later life. These findings suggest that monitoring and treatment of PTSD are important over the long term.
To estimate the prevalence of post-traumatic stress disorder (PTSD) and assess determinants related to PTSD symptoms among adult earthquake survivors after the 2008 Wenchuan earthquake in China.
Cross-sectional multicluster sample surveys with data collected from four counties.
Surveys were conducted separately in four counties in Sichuan Province, with a total of 2004 respondents. Beichuan County and Dujiangyan City were damaged more severely than Yaan County and Langzhong County during the earthquake. In total, 1890 households were represented, with a mean of 2.2 respondents per household. Data were collected using structured interviews, and the Harvard Trauma Questionnaire and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were used to diagnose PTSD.
The prevalence rates of suspected PTSD were 47.3% (n = 436) in heavily damaged areas and 10.4% (n = 93) in moderately damaged areas. The prevalence rates of PTSD symptoms among elderly, middle aged and young adults were 55.8%, 50.2% and 28.6% (P = 0.001), respectively, in heavily damaged areas. Older age, female gender, unmarried/divorced/widowed, ethnic minority, death of family member, no household income and damaged household were independent risk factors for PTSD symptoms in heavily damaged areas.
Interventions designed to reduce PTSD among populations affected by the 2008 earthquake should focus on people without household incomes, those with damaged households and those who experienced the death of a family member. Effective, sustainable and culturally sensitive psychosocial interventions and mental health services are required, and attention should be directed to survivors who experienced the death of a family member, women and older adults following the devastating natural disaster. Governments should support income-generating activities and improve living conditions. Trained field personnel can assist with PTSD assessments and referrals, and existing rural healthcare services can be used to provide treatment for common psychiatric disorders.
Pretrauma factors of psychiatric history and neuroticism have been important in highlighting vulnerability to posttraumatic stress disorder (PTSD), whereas posttrauma support mechanisms have been associated with positive health and well-being outcomes, particularly in veterans. The relationship between these factors and PTSD has not been the subject of a systematic review in veterans. An online search was conducted, supplemented by reference list and author searches. Two investigators systematically and independently examined eligible studies. From an initial search result of 2,864, 17 met inclusion criteria. A meta-analysis of unit cohesion involving 6 studies found that low unit cohesion was associated with PTSD, standardised mean difference of -1.62, 95% confidence interval (CI) [-2.80, -0.45]. A meta-analysis of social support involving 7 studies found that low social support was associated with PTSD, standardised mean difference of -12.40, 95% CI [-3.42, -1.38]. Three of 5 studies found a significant relationship between low-family support and PTSD; insufficient data precluded a meta-analysis. Regarding pretrauma vulnerability, 2 studies on psychiatric history and 1 on neuroticism found positive relationships with PTSD. Posttrauma factors of low support were associated with higher reporting of PTSD. Cross-sectional methodology may be inadequate to capture complex relationships between support and PTSD; more longitudinal research is required.
Purpose:
Exposure to earthquake has been associated with psychological distress, in particular, the development of posttraumatic stress disorder (PTSD). The aims of this study were to estimate the prevalence of PTSD, explore the associated risk factors among adult survivors 6 months after the Wenchuan earthquake in China, and compare the findings in our study to other studies about the Wenchuan earthquake and other earthquakes that occurred in the past.
Methods:
Multistage stratified random sampling methods were conducted in three severely affected areas in the Wenchuan earthquake. In this study, 14,798 individuals were identified with simple random selection methods at the sampling sites, 14,207 individuals were screened with the 12-item General Health Questionnaire(GHQ-12), and 3692 individuals were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders (SCID-I/P) by 180 psychiatrists.
Result:
The prevalence of PTSD was 15.57%. The risk factors for PTSD included old age, female gender, living alone, buried in the earthquake, injured in the earthquake, operated on after the earthquake, witnessing someone get injured in the earthquake, witnessing someone get buried in the earthquake, witnessing someone die in the earthquake (P<0.05, 95% CI).
Conclusion:
PTSD is common after a major disaster. Risk factors help people to identify the potential victims after disasters in time. Post-disaster mental health recovery interventions include early identification, sustained psychosocial support, governmental programs that provide social and economic support.
This study examined the nature and determinants of longitudinal trajectories of disaster-related posttraumatic stress disorder (PTSD) symptoms in older persons affected by a large-magnitude disaster. Two hundred six adults age 60 or older (mean = 69, range = 60-92) who resided in the Galveston Bay area when Hurricane Ike struck in September 2008 completed telephone interviews an average of 3-, 6-, and 15-months after this disaster. Latent growth mixture modeling was employed to identify predominant trajectories of disaster-related PTSD symptoms over time; and pre-, peri-, and post-disaster determinants of these trajectories were then examined. A 3-class solution optimally characterized PTSD symptom trajectories, with the majority (78.7%) of the sample having low/no PTSD symptoms over all assessments (i.e., resistant); 16.0% having chronically elevated symptoms (i.e., chronic); and 5.3% having a delayed onset course of symptoms (i.e., delayed-onset). Lower education, greater severity of Hurricane Ike exposure (i.e., Ike-related physical illness or injury and high level of community destruction), and greater number of traumatic and stressful life events after Hurricane Ike, particularly financial problems, were associated with a chronic PTSD trajectory. Greater number of traumatic and stressful life events, particularly financial problems after Hurricane Ike, was also associated with a delayed-onset trajectory. These findings suggest that there are heterogeneous trajectories of disaster-related PTSD symptoms in older adults and that these trajectories have common and unique determinants. They also underscore the importance of prevention efforts designed to mitigate the deleterious effects of post-disaster stressors, most notably financial distress, in older persons affected by disasters.
Many older adults have experienced or witnessed devastating life events including wars, hurricanes, and explosions. This study examined retraumatization and the relationship between certain risk factors, resilience, and psychological distress in the post-9/11 environment among 120 community-dwelling older adults. Results indicate that Holocaust survivors suffered more posttraumatic symptoms during the ongoing War on Terrorism than a comparison group. A significant contributor to posttraumatic symptomatology was anxiety followed by sense of safety, and survivor status. Clinicians should anticipate that older adults exposed again to trauma may experience posttraumatic symptomatology. Health-care practitioners should focus on distant history of trauma when assessing older adults for posttraumatic stress.
The purpose of this study was to investigate whether widowed status was associated with posttraumatic stress disorder (PTSD) in a sample of older adult women who had at least one traumatic event over their lifetime. Symptoms of depression and PTSD were examined in a nationally representative sample of 473 older adult widowed and married women. Consistent albeit not universally statistically significant trends revealed increased symptoms of PTSD, but not depression. The results are discussed within the framework of recent bereavement literature (e.g., complicated bereavement versus depression).
Derived and tested a short form of the Center for Epidemiologic Studies Depression Scale (CES-D) for reliability and validity among 1,206 well older adults (aged 65–98 yrs). The 10-item screening questionnaire, the CESD-10, showed good predictive accuracy when compared to the full-length 20-item version of the CES-D. The CESD-10 showed an expected positive correlation with poorer health status scores and a strong negative correlation with positive affect. Retest correlations for the CESD-10 were comparable to those in other studies. The CESD-10 was administered again after 12 mo. Data were based on 80% of the original sample. Scores were stable with strong correlation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The psychosocial effects of an earthquake which occurred in Newcastle, Australia in 1989 are the focus of the Quake Impact Study, a four-phase community survey conducted over 2 years. Comparisons were made between adults aged less than 65 years (N=2371) and those aged 65 years and older (N=636). Results revealed that older subjects reported fewer threat and disruption experiences and used fewer general and disaster-related support services. However, older subjects reported higher overall levels of post-traumatic stress symptoms on the Impact of Event Scale (IES) compared with younger subjects. On both the IES and a general measure of morbidity (General Health Questionnaire: GHQ-12) the effects of earthquake exposure were more marked among the elderly. Within the older group, subjects who had high levels of post-traumatic stress symptoms (IES>25,N=117) were more likely to be female, report higher levels of exposure and use behavioural and avoidance coping styles. Although psychological distress declined with time, post-traumatic stress symptoms remained higher for the high exposure group throughout the study. We conclude that older people may be more at risk for experiencing post-traumatic stress reactions despite having fewer disaster-related experiences. They may also underutilize support services following a disaster. Older women in particular and people with an avoidance coping style appear to be most vulnerable.
This study examines the psychometric properties of two versions of the PTSD Sympton Scale (PSS). The scale contains 17 items that diagnose PTSD according to DSM-III-R criteria and assess the severity of PTSD symptoms. An interview and self-report version of the PSS were administered to a sample of 118 recent rape and non-sexual assault victims. The results indicate that both versions of the PSS have satisfactory internal consistency, high test-retest reliability, and good concurrent validity. The interview version yielded high interrater agreement when administred separately by two interviewers and excellent convergent validity with the SCID. When used to diagnose PTSD, the self-report version of the PSS was somewhat more conservative than the interview version.
A household probability sample of 229 adults was interviewed four to seven months after the Sierra Madre earthquake (June 28, 1991; Los Angeles County). The study predicted psychological distress from these variables: demographics, traumatic event history, low magnitude event history, earthquake related threat perceptions, and earthquake related resource loss. Based on the Conservation of Resources (COR) stress model, it was predicted that resource loss would be central in predicting psychological distress. Three major hypotheses were supported: (1) resource loss was positively associated with psychological distress; (2) resource loss predicted psychological distress when other predictors were statistically controlled; and (3) resource loss was associated with mild to moderate elevations in of psychological distress. The findings support COR stress theory. Theoretical and practical implications are discussed.
Criterion symptoms of posttraumatic stress disorder (PTSD) were measured 6–12 months after Hurricane Andrew in the United States (non-Hispanic n = 270), Hurricane Paulina in Mexico (n = 200), and the 1997 flood in Poland (n = 285), using English, Spanish, and Polish versions of the Revised Civilian Mississippi Scale. The samples ranged in age from 18 to 88. Linear and quadratic effects of age were tested by using hierarchical multiple regression, with the effects of gender, trauma, and education controlled. Among Americans, age had a curvilinear relation with PTSD such that middle-aged respondents were most distressed. Among Mexicans, age had a linear and negative relation with PTSD such that younger people were most distressed. Among Poles, age had a linear and positive relation with PTSD such that older people were most distressed. Thus, there was no one consistent effect of age; rather, it depended upon the social, economic, cultural, and historical context of the disaster-stricken setting.
To present findings on the prevalence, correlates, and psychiatric comorbidity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition posttraumatic stress disorder (PTSD) and partial PTSD in a nationally representative sample of U.S. older adults.
Face-to-face interviews with 9,463 adults age 60 years and older in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.
Sociodemographic correlates; worst stressful experiences; comorbid lifetime mood, anxiety, substance use, and personality disorders; psychosocial functioning; and suicide attempts.
Lifetime prevalences ± standard errors of PTSD and partial PTSD were 4.5% ± 0.25 and 5.5% ± 0.27, respectively. Rates were higher in women (5.7% ± 0.37 and 6.5% ± 0.39) than in men (3.1% ± 0.31 and 4.3% ± 0.37). Older adults with PTSD most frequently identified unexpected death of someone close, serious illness or injury to someone close, and their own serious or life-threatening illness as their worst stressful events. Older adults exposed to trauma but without full or partial PTSD and respondents with partial PTSD most often identified unexpected death of someone close, serious illness or injury to someone close, and indirect experience of 9/11 as their worst events. PTSD was associated with elevated odds of lifetime mood, anxiety, drug use, and borderline and narcissistic personality disorders and decreased psychosocial functioning. Partial PTSD was associated with elevated odds of mood, anxiety, and narcissistic and schizotypal personality disorders and poorer psychosocial functioning relative to older adults exposed to trauma but without full or partial PTSD.
PTSD among older adults in the United States is slightly more prevalent than previously reported and is associated with considerable psychiatric comorbidity and psychosocial dysfunction. Partial PTSD is associated with significant psychiatric comorbidity, particularly with mood and other anxiety disorders.
To examine the prevalence and correlates of disaster-related posttraumatic stress disorder (PTSD), depression, and needs for psychological care in older persons affected by Hurricane Ike.
A total of 193 adults aged 60 or older who resided in the Galveston Bay area were interviewed 2-5 months following Hurricane Ike. Pre-, peri-, and post-disaster variables hypothesized to be related to PTSD and depressive symptoms, and perceived needs for psychological care were assessed.
Weighted prevalences of past-month Ike-related PTSD and depression were 7.6% and 8.6%, respectively. Risk factors for Ike-related PTSD symptoms were predominantly peri-disaster in nature, with greater hurricane exposure, and peri-event dissociative and autonomic activation symptoms associated positively with these symptoms. Risk factors for depressive symptoms were predominantly pre-disaster in nature, with being married/living with partner associated negatively, and prior disaster exposure and pre-disaster PTSD or depression associated positively with these symptoms. 27.2% of the sample endorsed at least one of the perceived needs for psychological care assessed. A history of PTSD or depression, greater peri-event autonomic activation, and Ike-related PTSD and depressive symptoms were associated with greater need for psychological care.
This study is limited by its cross-sectional design and employment of psychiatric screening instruments.
A substantial proportion of older adults may have PTSD and depression, as well as perceived needs for psychological care, after a disaster. Assessment of disaster exposures, and peri-event dissociative and autonomic symptoms may help identify older adults at risk for disaster-related psychopathology. Older adults with a history of PTSD or depression, and greater peri-event autonomic activation and PTSD symptoms may be more likely to have needs for psychological care.
To present findings on past-year medical conditions associated with lifetime trauma exposure and full and partial posttraumatic stress disorder (PTSD) in a nationally representative sample of U.S. older adults.
Face-to-face diagnostic interviews.
Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.
Nine thousand four hundred sixty-three adults aged 60 and older.
Logistic regression analyses adjusting for sociodemographic characteristics and psychiatric comorbidity were used to evaluate associations between PTSD status and past-year medical disorders; linear regression models evaluated associations with past-month physical functioning.
After adjustment for sociodemographic characteristics and comorbid lifetime mood, anxiety, substance use, attention-deficit/hyperactivity, and personality disorders, respondents with lifetime PTSD were more likely than respondents who reported experiencing one or more traumatic life events but who did not meet lifetime criteria for full or partial PTSD (trauma controls) to report being diagnosed with hypertension, angina pectoris, tachycardia, other heart disease, stomach ulcer, gastritis, and arthritis (odds ratios (ORs) = 1.3-1.8) by a healthcare professional; they also scored lower on a measure of physical functioning than controls and respondents with partial PTSD. Respondents with lifetime partial PTSD were more likely than controls to report past-year diagnoses of gastritis (OR = 1.7), angina pectoris (OR = 1.5), and arthritis (OR = 1.4) and reported worse physical functioning. Number of lifetime traumatic event types was associated with most of the medical conditions assessed; adjustment for these events reduced the magnitudes of and rendered nonsignificant most associations between PTSD status and medical conditions.
Older adults with lifetime PTSD have high rates of several physical health conditions, many of which are chronic disorders of aging, and poorer physical functioning. Older adults with lifetime partial PTSD have higher rates of gastritis, angina pectoris, and arthritis and poorer physical functioning.
We examined the validity of the PTSD Symptom Scale - Self-Report (PSS-SR) as a screening instrument for post-traumatic stress disorder (PTSD) in patients recovering from first-episode psychosis.
Sixty-one patients from the Early Psychosis Intervention Programme in Singapore completed the PSS-SR questionnaire. The Clinician-Administered PTSD Scale was administered by a blinded interviewer as the 'gold standard' to identify patients with PTSD. The sensitivity, specificity and receiver operating characteristic curve were used to determine the screening performance of the PSS-SR.
The score representing the optimal cut-off point for the PSS-SR was 14, with a sensitivity and specificity of 0.83 and 0.71, respectively. The area under the curve was determined to be 0.82 (95% CI: 0.70-0.95).
These data suggest that the PSS-SR can be a useful screening instrument for PTSD in patients recovering from their first psychotic episode.
The catastrophic Wenchuan earthquake measuring 8.0 on the Richter scale occurred on May 12, 2008 in the West of the Sichuan basin in China and caused severe damage. A project was undertaken to examine the cognitive and psychological effects one year after the disaster among 2080 individuals in the local area. We evaluated the influence of gender, age, education level, and ethnic group on five aspects: work satisfaction, living satisfaction, health self-perception, psychological pressure, and psychological recovery. Male subjects had a better performance in all five aspects, which indicated that women were more affected. Subjects of different ethnic groups showed significantly different attitudes with respect to psychological pressure and psychological recovery. Significant differences for all the five aspects were also found in education level and age. The results showed that older people and those with a lower education level probably had more psychological problems. There were significant correlations between work satisfaction and living satisfaction, living satisfaction and health self-perception, living satisfaction and psychological recovery, and psychological pressure and psychosocial recovery. Living satisfaction and education level were significant predictors of psychological pressure. For psychological recovery, significant predictors were living satisfaction, age, work satisfaction, education level, and gender. The study findings indicated that government programs should provide more support for females, older people, those with a lower education level, and those in lower living conditions. Attention should be given not only to the psychological effects on each victim, but also to related issues such as work and living conditions to promote psychological wellbeing. Limitations of this study are addressed.
Most children who experience trauma recover and display resilience; however, there are few long-term follow-up studies of traumatized children and fewer still have examined factors that may lead to resilience. This study is a 20-year follow-up of adults who experienced an earthquake as children.
Nineteen of 25 adults who experienced the earthquake in Armenia in 1988 and participated in the initial study approximately two years later (Time 1) were reinterviewed in 2008 (Time 2). Forty-four Armenian adults aged 22-37 who had not experienced the earthquake comprised the comparison group. All participants at Time 2 were administered the Symptom Checklist-90 Revised (SCL-90-R) and the UCLA PTSD Reaction Index (RI) and also received a clinical interview.
The earthquake group had clinically elevated SCL-90-R GSI, PSDI, PST and subscale scores for all but one subscale and had significantly more subscale clinical elevations than the comparison group. All earthquake survivors at Time 2 scored from 1 to 46 on the RI with 4 having probable PTSD. No comparison subjects had experienced an A1 trauma.
The small number of subjects in this follow-up, our inability to follow the comparison group in the original study and the measures used at the two time points limits the applicability of the results.
Most of the earthquake survivors experienced anxiety disorders at follow-up but not high levels of PTSD or depression. Clinical interviews identified resilient factors that may have helped these subjects maintain functional and adaptive capacities despite clinical elevations on the SCL-90.
Exposure to earthquakes has been associated with psychological distress in particular, the development of posttraumatic stress disorder (PTSD). The aims of this study are to estimate the prevalence of PTSD, explore the associated risk factors among survivors 1 year after the Wenchuan earthquake in China, and compare the findings in our study to other disasters. Cross-sectional sample survey was conducted to collect data in severely affected counties. We use the PTSD Check List-Civilian Version, which consists of 17 items corresponding to each symptom in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD criteria B, C, and D. The prevalence estimates of probable PTSD in our sample ranged from 21.5% (based on Check List-Civilian Version score of 50 or higher) to 40.1% (based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). The prevalence of PTSD was high, compared with rates of PTSD in previous studies. Low social support, feeling fear during the earthquake, female, young people, Han nationality, low monthly income, and low educational level were risk factors significantly related to the development of PTSD. Postdisaster mental health recovery interventions including early identification, ongoing monitoring, and sustained psychosocial support are required for the high-risk population with PTSD. Existing rural and urban health care services should be convenient for people, and special measures need to be designed, such as home visits and mobile clinics.
Heart disease, poor mental health, and abuse are epidemic among women worldwide. Our purpose was to identify a group of women with heart disease and explore the relationship between a history of abuse and existing symptoms of depression and post-traumatic stress disorder (PTSD) and analyze the relationships over time. A prospective cohort analysis design with mental health measures repeated at 3 and 6 months postintake was followed. Abused women (n = 25) reported significantly more symptoms of depression (p = .004) and PTSD (p = .003) compared with nonabused women (n = 14). To promote global mental health among women with heart disease, interventions must address a history of abuse.
In a panel study, more than 200 older adults were interviewed before and after a severe flood in southeastern Kentucky in 1984. The issue in this study was whether older adult flood victims were differentially vulnerable to increases in psychological and physical symptoms on the basis of their age, sex, marital status, occupational status, education level, and preflood symptom levels. Flood exposure was related to increases in depressive, anxiety, and somatic symptoms at 18 months postflood. Within this older adult sample, men, those with lower occupational status, and persons aged 55-64 were at significantly greater risk for increases in psychological symptoms. Sociodemographic status did not moderate the impact of flood exposure on physical health. Implications for crisis-intervention services to older adult disaster victims are discussed.
This study was undertaken 1 1/2 years after the 1988 earthquake in Armenia to assess the frequency and severity of posttraumatic stress reactions among elderly and younger adult victims and to assess the relation of exposure, age, sex, and death of a family member to these reactions.
One hundred seventy-nine subjects of both sexes were evaluated with the Posttraumatic Stress Disorder (PTSD) Reaction Index. A subgroup of 60 individuals were also assessed for PTSD with the DSM-III-R criteria.
There was a strong association between the presence of severe symptoms on the index and a DSM-III-R diagnosis of PTSD. Elderly and younger adult victims in cities closer to the epicenter (higher exposure) had significantly higher index scores than elderly and adult victims in more distant locations. In comparison with previous studies of natural disasters, much greater rates of chronic severe posttraumatic stress reactions were found among the highly exposed individuals. Although there was no difference in total mean score on the Posttraumatic Stress Disorder Reaction Index, a significant difference in symptom profile was found between the elderly and younger adults; the elderly scored higher on arousal symptoms and lower on intrusive symptoms. There was a positive correlation between loss of family members and severity of posttraumatic stress reaction.
These findings indicate that after a major natural disaster with subsequent multiple adversities, a substantial proportion of the adult population may experience severe and chronic posttraumatic stress reactions. The risk factors identified in this study may prove useful in screening exposed individuals for appropriate treatment.
It is clear from the existing data that PTSD often occurs in the context of other major psychological conditions. Evidence to support this comes from clinical studies, epidemiological studies, and studies of PTSD among substance abusers. Clearly, probably several different subgroups of PTSD patients exist including those who had psychological or behavioral problems before exposure to traumatic events (e.g., substance abuse), those who developed other problems concurrent with exposure to the traumatic events, and those who developed problems secondary to the development of PTSD, perhaps in efforts to cope with the intensely debilitating symptoms of PTSD. With this knowledge, research on PTSD must begin to contend with the comorbidity issue in systematic ways. The use of comparison groups that are carefully selected is one key way in which conclusions about PTSD can be most conservatively drawn. The use of statistical procedures to control for difference in levels of comorbidity is another responsible way in which to approach the problem. Finally, efforts to employ global measures of functioning such as the Global Assessment of Functioning to equate subjects within a study on minimally this characteristic may be the most economical method for trying to rule out the role of comorbidity and severity of condition in conclusions drawn in research studies. All these solutions presuppose the careful measurement of comorbidity in studies of PTSD, a recommendation that requires serious consideration for researchers operating in this field.
Through the joint efforts of the area community mental health center and an emergency relief organization, psychological reactions of flood victims were measured. A random sample of 124 adults and 54 children were interviewed, using scales reflecting measures of depression and stress. Results showed that adults perceived themselves to be significantly more depressed and stressed in areas such as adaptation and physical complaints. Children's results were mixed, depending on age, although problems existed with regressive and aggressive behaviors, fears, and in miscellaneous areas such as sleep difficulty. Recommendations are made for further community mental health involvement, as well as emphasizing the need for further empirical work in the assessment of postdisaster emotional sequelae.
Issues that are salient in understanding posttraumatic stress disorder (PTSD) in older adults are examined in this review. Although this issue has received scattered attention in the literature since introduction of the diagnosis of PTSD to the Diagnostic and Statistical Manual (DSM) in 1980, it is clear that numerous conceptual and defining questions exist in our understanding of the aftermath of trauma exposure in older adults. In approaching this issue, studies pertaining to diagnostic status as well as broader dimensions of psychosocial functioning are examined. Concerns that are unique to older adults are highlighted throughout, with particular attention to areas where additional research is warranted.
We review research findings on the oldest old that demonstrate that the fourth age entails a level of biocultural incompleteness, vulnerability and unpredictability that is distinct from the positive views of the third age (young old). The oldest old are at the limits of their functional capacity and science and social policy are constrained in terms of intervention. New theoretical and practical endeavors are required to deal with the challenges of increased numbers of the oldest old and the associated prevalence of frailty and forms of psychological mortality (e.g., loss of identity, psychological autonomy and a sense of control). Investigation of the fourth age is a new and challenging interdisciplinary research territory. Future study and discussion should focus on the critical question of whether the continuing major investments into extending the life span into the fourth age actually reduce the opportunities of an increasing number of people to live and die in dignity.
This longitudinal study examines changes in depressive symptoms among displaced older Taiwanese adults (N = 54, M = 68 years), and the impact of various social supports for them at between 6 and 12 months after an earthquake. The average depression score between 6 and 12 months following the earthquake was unchanged and kept high score. Child and extended family support levels related to depressive symptoms after 6 months. In contrast, after 12 months, significant factors associated with a lessening of the depressive symptoms were social support from the extended family and neighbors, and social participation. Intervention to promote increased social networks and social participation, within their new environment in a temporary community, is highly recommended for older adults.
This study explored the psychopathological reactions to a natural disaster and their respective risk factors among the elderly in Honduras and their vulnerability as compared to other adults. STUDY SUBJECTS AND SAMPLE: Eight hundred respondents of both genders aged 15 years and above, of which 103 were 60 and over, were selected from high, middle and low residential status areas in Tegucigalpa that had suffered high and low exposure to the devastating effects of Hurricane Mitch. RESEARCH INSTRUMENTS: CIDI was used to diagnose PTSD and the Impact of Events Scale was administered as a measure of severity of post-traumatic reaction. Depression and alcohol misuse were examined using screening instruments. The SRQ was used as both a measure of emotional distress and dichotomized to screen for probable psychiatric disorder.
PTSD, depression and SRQ-case were found, respectively in 13.6%, 18.8%, and 21.4% of the elderly. Their reactions did not differ in frequency than of those of younger adults. Among the elderly, pre-hurricane psychological problems and the intensity of exposure were associated with increased risk for all outcomes measured except for alcohol misuse.
No evidence was found for a differential vulnerability on the part of the elderly as compared with younger adults. Among the elderly increasing age was not a factor.
Natural disasters, such as earthquakes, can have deleterious consequences for physical and psychological health. In this study, we investigate variability in resilience to depressive symptoms in the aftermath of a massive earthquake that struck Taiwan in 1999. We analyze data on 1160 older individuals from a national, longitudinal survey with interviews before and after the earthquake. This survey contains extensive information on physical and cognitive function, depressive symptoms, socio-demographic characteristics and earthquake-related exposure and experiences. We estimate regression models to identify risk factors associated with the presence of depressive symptoms after the disaster, controlling for health status and the presence of depressive symptoms beforehand. We pay special attention to how socio-demographic factors moderate the psychological impact of the earthquake. Results indicate that persons of low socioeconomic status (SES), socially isolated individuals, and women reported higher levels of depressive symptoms than their respective counterparts, as did persons who experienced damage to their homes. The psychological effects of damage were strongest among those aged 54-70. The findings suggest that people who experience damage to their home during a disaster are at risk of experiencing depressive symptoms, with the elderly being more resilient than the near-elderly.